Whitacre or Quincke needles - does it really matter

Background: Postdural puncture headache (PDPH) and backache are well known complications of spinal anaesthesia. The incidence of PDPH may be significant in young people (<50 years). The present study was undertaken in order to compare the utility and complication rate of the Whitacre and Ouincke spinal needles. Methods: During three years all patients who could comply, and who were to undergo spinal anaesthesia at the Department were asked to join this quality control study. Each one received a questionnaire including questions about discomfort and other possible side effects attributed to spinal anaesthesia. In each case, an extended anaesthetic record was filled out by the anaesthesiologist. About 50 anaesthesiologists at different educational levels were involved. Results: The study includes 2598 cases, of which questionnaires were returned by 66%. Needles of the 25 G gauge size were used in over 90% of the cases. Multiple skin punctures were required more frequently in the Quincke than in the Whitacre group (P<0.01). The number of insufficient blocks was also higher in the Quincke group (P<0.01). There was a higher incidence of backache in the Quincke group (P<0.05). In patients under 50 years, PDPH was more frequent following use of the Quincke needle (P<0.05), whereas no difference between the needles in this regard was found among those over 50 years (P>0.05). Conclusions: For routine clinical use the Whitacre needle appears to be associated with better performance and increased reliability. In younger patients the Whitacre needle have the additional advantage of decreasing the risk of postdural puncture headache.