The incidence of post-dural puncture headache (PDPH) after the use of a standard spinal needle (Quincke) is, firstly, dependent on the size of the needle. In young female patients the mean incidence of PDPH, calculated from different studies, is around 15% when using a 25G needle and around 5% when using a 26G needle. Hurley et al reported a significant reduction in PDPH from 6.3% to 2.5% using a 27G needle instead of a 26G one in obstetric patients (1). The incidence can be further reduced by puncturing the dura parallel to the dural fibers and at a small angle (2, 3) (Chapter 97).

New spinal needles with special tip design (all modifications of the original pencil point Hart and Whitacre needle (4)) have lowered the incidence of post-dural puncture headache (PDPH) to an acceptable level. Figure E.1. shows some of the currently-available needle tip designs.

In 1987 Sprotte et al. introduced the 'atraumatic' spinal needle (a modified pencil point needle) and reported that the incidence of PDPH could be reduced to less than 1% (5). Although more authors reported the very low incidence of PDPH using the Sprotte needle, a higher failure rate was reported and related to the dimensions and placement of the sideport of this needle (6). The modern Whitacre needles, with a smaller sideport closer to the tip, are superior to the Sprotte needle and their use has reduced the incidence of significant PDPH to less than 1% (7).

A modern Whitacre 25G needle is easy to handle, results in few failures and is highly recommended in obstetric patients.

References:
1. Hurley RJ, Hertwig LM, Lambert DH. Incidence of PDPH in the obstetric patient: 25G Whitacre vs 26 and 27G Quincke tip needles. Regional Anesthesia 1992; 17:35 Supplement.

2. Gielen MJM. Postdural puncture headache (PDPH): a review. Regional Anesthesia 1989;14:101-106.

3. Gielen MJM. How to prevent postdural puncture headache. International Monitor on Regional Anesthesia 1994;6;2-7.

4. Hart JR, Whitacre RG. Pencil-point needle in prevention of postspinal headache. JAMA 1951;147:657-58.

5. Sprotte G, Schedel R, Pajunk H. An atraumatic needle for single shot regional anaesthesia. Regional Anaesthesie 1987;10:104-108.

6. Crone LL, Vogel W. Failed spinal anaesthesia with the Sprotte needle. Anesthesiology 1991;75:717-718.

7. Halpern S, Preston R. Postdural puncture headache and spinal needle design. Meta-analyses. Anesthesiology 1994;81:1376-83.

Recent references on this topic include:
Krommendijk EJ, Verheijen R, van Dijk B, Spoelder EM, Gielen MJ, de Lange JJ. The PENCAN 25-gauge needle: a new pencil-point needle for spinal anesthesia tested in 1,193 patients. Reg Anesth Pain Med. 1999 Jan-Feb;24(1):43-50.