Large Spinal Needle Gauges Do Not Increase Incidence of Headaches in Orthopedic Patients

Newswise — Spinal anesthesia is a common intervention for lower body orthopedic procedures, with research showing fewer symptoms compared to general anesthesia. However, spinal anesthesia may lead to post-dural puncture headache (PDPH). This potential complication of spinal injections causes debilitating head pain that worsens with sitting or standing and improves with lying down. The risk of PDPH increases for larger gauge and non-pencil point cutting needles in younger women receiving spinal injections for labor. However, whether those risk factors are the same for older women and men undergoing orthopedic procedures is not known. These patients have narrowed spaces between spinal vertebrae and more brittle ligaments, making successful performance of spinal anesthesia more difficult and prompting practitioners to use larger gauge cutting spinal needles to improve the chances of success. A new study sought to bring clarity to this risk by comparing the incidence of PDHP in orthopedic patients who receive spinal injections with either a 22-gauge Quincke cutting needle versus a 25-gauge pencil-point needle.

Andrew Wong, Joshua Dooley, Jeff Gadsden, and Dan Weikel of Duke University Medical Center, Durham, NC, received a Resident/Fellow Travel Award from the American Society of Regional Anesthesia and Pain Medicine (ASRA) for its 46th Annual Regional Anesthesiology and Acute Pain Medicine Meeting, being held May 13-15, 2021. The authors will present Abstract #1807, “Spinal Needle Gauge & Type and PDPH Incidence in Orthopedic Patients,” on Saturday, May 15.

In their large retrospective chart review, Wong et al. collected data for almost 4000 orthopedic patients undergoing lower body surgery. The patients, aged 18 to 90 years old, were 52% female and 48% male, with an average body mass index of 29.57. Regardless of needle size, none of the patients experienced PDPH. This finding has exciting implications for reducing PDPH risk.

“Given the benefits of larger gauge cutting needles in performing successful spinals, these results suggest that practitioners can opt for these needles first, reducing the number of attempts needed for success and minimizing the overall time for the procedure, patient discomfort from multiple attempts, and the waste of smaller non-cutting needles,” Wong et al. said.