{"id":54826,"date":"2026-05-26T16:11:40","date_gmt":"2026-05-26T14:11:40","guid":{"rendered":"https:\/\/campusvygon.com\/global\/?p=54826"},"modified":"2026-05-26T17:08:25","modified_gmt":"2026-05-26T15:08:25","slug":"preventing-post-dural-puncture-headache-pdph","status":"publish","type":"post","link":"https:\/\/campusvygon.com\/global\/preventing-post-dural-puncture-headache-pdph\/","title":{"rendered":"Preventing Post-Dural Puncture Headache (PDPH) during spinal anaesthesia: Optimising needle choice and technique for high-risk patients"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><strong>What is Post-Dural Puncture Headache (PDPH) and when is active prevention&nbsp;indicated?<\/strong>&nbsp;<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Post-Dural Puncture Headache (PDPH)&nbsp;is a positional headache that occurs within 5 days of a dural puncture,&nbsp;is relieved&nbsp;by lying&nbsp;down, and lasts \u22642 weeks or resolves following an epidural blood patch (EBP).&nbsp;<sup>4<\/sup>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">It occurs due to cerebrospinal fluid (CSF) leakage and is highly preventable by<strong>&nbsp;optimising&nbsp;the type of needle and the operator\u2019s technique.<\/strong>&nbsp;<sup>3-7<\/sup>&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Incidence:&nbsp;<\/strong>Varies from 0.5% to 25% or more, depending heavily on needle design,&nbsp;gauge&nbsp;and patient factors.&nbsp;<sup>4<\/sup><sup>&#8211;<\/sup><sup>6<\/sup>&nbsp;<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Clinical impact:&nbsp;<\/strong>Causes debilitating pain, prolonged&nbsp;hospitalisation&nbsp;and frequent need for an&nbsp;epidural blood patch (EBP).&nbsp;<sup>4\u20137\u20138<\/sup>&nbsp;<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Serious complications:&nbsp;<\/strong>Although rare, it can lead to subdural&nbsp;haematoma, cranial nerve&nbsp;palsy&nbsp;or arachnoiditis.&nbsp;<sup>4-7<\/sup>.&nbsp;<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>High-risk patients<\/strong>: Pregnant women, children, elderly&nbsp;people&nbsp;and&nbsp;low&nbsp;Body&nbsp;Mass Index (BMI).<sup>&nbsp;4-7<\/sup><sup>&nbsp;<\/sup>&nbsp;<\/li>\n<\/ul>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Post-Dural Puncture Headache (PDPH) as a significant clinical problem<\/strong>&nbsp;<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The primary\u00a0objective\u00a0of healthcare professionals is to guide patients towards\u00a0a<strong> safe and smooth surgical recovery<\/strong> by promoting\u00a0optimal\u00a0pain control and reducing\u00a0<a href=\"https:\/\/campusvygon.com\/global\/benefits-using-custom-packs-for-local-regional-anaesthesia\/\" data-type=\"link\" data-id=\"https:\/\/campusvygon.com\/global\/benefits-using-custom-packs-for-local-regional-anaesthesia\/\">anesthesia<\/a>-associated.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">However,&nbsp;Post-Dural Puncture Headache (PDPH)&nbsp;remains&nbsp;a&nbsp;common&nbsp;and stressful complication that hinders this&nbsp;objective.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The impact of this complication goes far beyond a simple headache; <strong>it&nbsp;immobilises&nbsp;patients, delays the mother-infant bond in&nbsp;obstetrics&nbsp;and exponentially increases medical costs<\/strong>.&nbsp;<sup>8-9<\/sup>&nbsp;<\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Modifiable risk factors: Needle type, technique and experience<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Needle bevel design<\/strong>&nbsp;<\/h3>\n\n\n\n<div style=\"height:65px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<div class=\"ntb_table_wrapper ninja_table_builder_instance_0\"\n     id='ninja_table_builder_54857'\n     data-ninja_table_builder_instance=\"ninja_table_builder_instance_0\"\n     style=\"\n     max-height:1500px;\n     max-width: 1500px;margin-left: auto; margin-right: auto;\">\n    <table id=\"ntb_table\" role=\"table\" class=\"table ninja_tables_builder_class_54857 ntb_54857\" style=\"margin: 0px auto;border-collapse: separate;border: 0px solid #000000;font-family: inherit;border-spacing: 7px\"><tbody class=\"tbody\"><tr class=\"desktop-view tr_class_2078727\" id=\"tr_id_2078727\" data-draggable=\"true\" style=\"background: #004133\"><td id=\"td_id_01070807\" class=\"td_class_01070807 table-data\" rowspan=\"1\" colspan=\"2\" style=\"padding: 12px;max-width: 200px;min-width: 200px\"><div id=\"cell_01070807\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 2px 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 20px;display: block;text-align: center;color: #ffffff;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_0\">Cutting tip needle<\/span><\/div><\/div><\/div><\/td><td id=\"td_id_88770870\" class=\"td_class_88770870 table-data\" rowspan=\"0\" colspan=\"0\" style=\"padding: 12px;max-width: 200px;min-width: 200px;display: none\"><div id=\"cell_88770870\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"placeholder hover-item mce-content-body\" id=\"mce_2\" style=\"padding: 2px 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 15px;display: block;text-align: center;color: #000001;opacity: 0.4;line-height: 1.2\"><br data-mce-bogus=\"1\"><\/span><\/div><\/div><\/div><\/td><td id=\"td_id_77777788\" class=\"td_class_77777788 table-data\" rowspan=\"1\" colspan=\"2\" style=\"padding: 12px;max-width: 200px;min-width: 200px\"><div id=\"cell_77777788\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 2px 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 20px;display: block;text-align: center;color: #ffffff;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_3\">Pencil point tip needle<\/span><\/div><\/div><\/div><\/td><td id=\"td_id_27877877\" class=\"td_class_27877877 table-data\" rowspan=\"0\" colspan=\"0\" style=\"padding: 12px;max-width: 200px;min-width: 200px;display: none\"><div id=\"cell_27877877\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" id=\"mce_4\" style=\"padding: 2px 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 20px;display: block;text-align: center;color: #ffffff;opacity: 1;line-height: 1.2;position: relative\">LISA\/MIST<\/span><\/div><\/div><\/div><\/td><\/tr><tr class=\"desktop-view tr_class_6332953\" id=\"tr_id_6332953\" data-draggable=\"true\" style=\"background: #ffffff\"><td id=\"td_id_96950391\" class=\"td_class_96950391 table-data\" rowspan=\"1\" colspan=\"1\" style=\"padding: 12px;max-width: 200px;min-width: 200px;background-color: #bccfbf;border: 1px solid #ffffff\"><div id=\"cell_96950391\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 15px;display: block;text-align: center;color: #004133;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_5\">Design and Advantages<\/span><\/div><\/div><\/div><\/td><td id=\"td_id_92658701\" class=\"td_class_92658701 table-data\" rowspan=\"1\" colspan=\"1\" style=\"padding: 12px;max-width: 200px;min-width: 200px;background-color: #a14c4c;border: 1px solid #ffffff\"><div id=\"cell_92658701\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 2px 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 15px;display: block;text-align: center;color: #ffffff;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_6\">Risks and Disadvantages<\/span><\/div><\/div><\/div><\/td><td id=\"td_id_69157890\" class=\"td_class_69157890 table-data\" rowspan=\"1\" colspan=\"1\" style=\"padding: 12px;max-width: 200px;min-width: 200px;background-color: #bccfbf;border: 1px solid #ffffff\"><div id=\"cell_69157890\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 15px;display: block;text-align: center;color: #004133;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_7\">Design and Advantages<\/span><\/div><\/div><\/div><\/td><td id=\"td_id_22792485\" class=\"td_class_22792485 table-data\" rowspan=\"1\" colspan=\"1\" style=\"padding: 12px;max-width: 200px;min-width: 200px;background-color: #a14c4c;border: 1px solid #ffffff\"><div id=\"cell_22792485\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 15px;display: block;text-align: center;color: #ffffff;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_8\">Risks and Disadvantages<\/span><\/div><\/div><\/div><\/td><\/tr><tr class=\"desktop-view tr_class_8139039\" id=\"tr_id_8139039\" data-draggable=\"true\" style=\"height: 100px\"><td id=\"td_id_57944755\" class=\"td_class_57944755 table-data\" rowspan=\"1\" colspan=\"1\" style=\"padding: 12px;max-width: 200px;min-width: 200px;background-color: #fafafa;border: 1px solid #ffffff\"><div id=\"cell_57944755\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 15px;display: block;text-align: center;color: #000001;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_9\">It has a cutting bevel that facilitates a rapid flow of CSF during the puncture. 7<\/span><\/div><\/div><\/div><\/td><td id=\"td_id_16425210\" class=\"td_class_16425210 table-data\" rowspan=\"1\" colspan=\"1\" style=\"padding: 12px;max-width: 200px;min-width: 200px;background-color: #fafafa;border: 1px solid #ffffff\"><div id=\"cell_16425210\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 15px;display: block;text-align: center;color: #000001;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_10\">Cuts the dural fibres, causing greater trauma and a higher incidence of PDPH (e.g. 8.5% with a 25G needle). 3-6<\/span><\/div><\/div><\/div><\/td><td id=\"td_id_10664486\" class=\"td_class_10664486 table-data\" rowspan=\"1\" colspan=\"1\" style=\"padding: 12px;max-width: 200px;min-width: 200px;background-color: #fafafa;border: 1px solid #ffffff\"><div id=\"cell_10664486\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 15px;display: block;text-align: center;color: #000001;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_11\">It separates the fibres without cutting them, reducing trauma and facilitating closure of the dural opening. 3-6<\/span><\/div><\/div><\/div><\/td><td id=\"td_id_80598816\" class=\"td_class_80598816 table-data\" rowspan=\"1\" colspan=\"1\" style=\"padding: 12px;max-width: 200px;min-width: 200px;background-color: #fafafa;border: 1px solid #ffffff\"><div id=\"cell_80598816\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 15px;display: block;text-align: center;color: #000001;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_12\">Very fine needles may make the technique difficult and require more attempts by the operator. 5-7<\/span><\/div><\/div><\/div><\/td><\/tr><tr class=\"desktop-view tr_class_3272363\" id=\"tr_id_3272363\" data-draggable=\"true\" style=\"height: 200px;background: #ffffff\"><td id=\"td_id_84988559\" class=\"td_class_84988559 table-data\" rowspan=\"1\" colspan=\"2\" style=\"padding: 12px;max-width: 200px;min-width: 200px;background-color: #fafafa;border: 1px solid #ffffff\"><div id=\"cell_84988559\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 0px 0px 25px;font-weight: bold;font-style: normal;text-decoration: none;font-size: 20px;display: block;text-align: center;color: #000001;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_13\">Context of Use<\/span><\/div><\/div><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 15px;display: block;text-align: left;color: #000001;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_14\">Avoid in high-risk patients. If used, the bevel should be aligned parallel to the fibres. 4<\/span><\/div><\/div><\/div><\/td><td id=\"td_id_15079868\" class=\"td_class_15079868 table-data\" rowspan=\"0\" colspan=\"0\" style=\"padding: 12px;max-width: 200px;min-width: 200px;background-color: #fafafa;display: none;border: 1px solid #ffffff\"><div id=\"cell_15079868\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" id=\"mce_15\" style=\"padding: 0px 0px 25px;font-weight: bold;font-style: normal;text-decoration: none;font-size: 20px;display: block;text-align: center;color: #000001;opacity: 1;line-height: 1.2;position: relative\">Context of Use<\/span><\/div><\/div><\/div><\/td><td id=\"td_id_76941656\" class=\"td_class_76941656 table-data\" rowspan=\"1\" colspan=\"2\" style=\"padding: 12px;max-width: 200px;min-width: 200px;background-color: #fafafa;border: 1px solid #ffffff\"><div id=\"cell_76941656\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 0px 0px 25px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 20px;display: block;text-align: center;color: #000001;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_16\"><span style=\"font-weight: bold;text-align: center\" data-mce-style=\"font-weight: bold; text-align: center;\">Context of Use<\/span><\/span><\/div><\/div><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" style=\"padding: 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 15px;display: block;text-align: left;color: #000001;opacity: 1;line-height: 1.2;position: relative\" id=\"mce_17\">Preferred choice, incidence &lt;3% (with a 25G needle): ideal in obstetrics and for vulnerable patients. 3<\/span><\/div><\/div><\/div><\/td><td id=\"td_id_52873413\" class=\"td_class_52873413 table-data\" rowspan=\"0\" colspan=\"0\" style=\"padding: 12px;max-width: 200px;min-width: 200px;background-color: #fafafa;display: none;border: 1px solid #ffffff\"><div id=\"cell_52873413\"><div class=\"single-item other-item\" data-draggable=\"true\"><div class=\"ntb-datas-wrapper\" style=\"margin: 1px\"><span data-v-bd450b80=\"\" data-placeholder=\"Add New\" class=\"hover-item mce-content-body\" id=\"mce_18\" style=\"padding: 0px;font-weight: normal;font-style: normal;text-decoration: none;font-size: 15px;display: block;text-align: left;color: #000001;opacity: 1;line-height: 1.2;position: relative\">Preferred choice, incidence &lt;3% (with 25G); ideal in obstetrics and for vulnerable patients. 3<\/span><\/div><\/div><\/div><\/td><\/tr><\/tbody><\/table><\/div>\n\n\n\n\n<div style=\"height:65px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Selecting an <strong>atraumatic pencil-tip needle is the most effective preventive measure to avoid Post-Dural Puncture Headache (PDPH)<\/strong>, making this choice a direct decision\u00a0regarding\u00a0safety.<sup>3-6<\/sup>\u00a0<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Needle gauge<\/strong>&nbsp;<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Using a smaller gauge (e.g.&nbsp;25G or 27G) inherently <strong>reduces the overall risk<\/strong> of developing&nbsp;Post-Dural Puncture Headache (PDPH).&nbsp;<sup>5\u20137<\/sup>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">However, design matters more than gauge alone: a 27G cutting&nbsp;needle has a 5\u201312%&nbsp;Post-Dural Puncture Headache (PDPH)&nbsp;rate, compared with a 25G&nbsp;pencil point&nbsp;needle at &lt;3%.&nbsp;<sup>3\u20136<\/sup><\/p>\n\n\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;6a15e1abbdcf0&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"6a15e1abbdcf0\" class=\"wp-block-image aligncenter size-large wp-lightbox-container\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"573\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on--pointerdown=\"actions.preloadImage\" data-wp-on--pointerenter=\"actions.preloadImageWithDelay\" data-wp-on--pointerleave=\"actions.cancelPreload\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/campusvygon.com\/global\/wp-content\/uploads\/sites\/10\/2026\/05\/zoom-Biseau-PP-vs-Cutting-article-PDPH-1024x573.png\" alt=\"Side\u2011by\u2011side comparison of two spinal needle tips and their effects on the dura mater. On the left, a pencil\u2011point (atraumatic) needle and a cutting (Quincke) needle are shown entering a grey tissue surface. The atraumatic needle has a rounded tip with a lateral opening, while the cutting needle has a sharp beveled edge. On the right, the resulting dural defects are illustrated: the atraumatic needle creates a small, slit\u2011like opening, whereas the cutting needle produces a larger, jagged tear. The image highlights the difference in tissue damage between needle types, with the atraumatic needle causing less disruption.\" class=\"wp-image-54829\" srcset=\"https:\/\/campusvygon.com\/global\/wp-content\/uploads\/sites\/10\/2026\/05\/zoom-Biseau-PP-vs-Cutting-article-PDPH-980x548.png 980w, https:\/\/campusvygon.com\/global\/wp-content\/uploads\/sites\/10\/2026\/05\/zoom-Biseau-PP-vs-Cutting-article-PDPH-480x268.png 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) and (max-width: 980px) 980px, (min-width: 981px) 1024px, 100vw\" \/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\tdata-wp-bind--aria-label=\"state.thisImage.triggerButtonAriaLabel\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.thisImage.buttonRight\"\n\t\t\tdata-wp-style--top=\"state.thisImage.buttonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><figcaption class=\"wp-element-caption\">Two types of spinal needle tips: \u201cAtraumatic needle\u201d (upper) and \u201ccutting needle\u201d (lower) of the same diameter (left). As shown on the right, the atraumatic needle causes a smaller dural defect (upper) than the cutting needle (lower). The smaller defect should theoretically result in a lower incidence of post-lumbar puncture headache.<\/figcaption><\/figure>\n\n\n\n<div style=\"height:49px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>High-risk patients: Considerations and complications (Clinical nuances)<\/strong>&nbsp;<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Some patients have an exceptional physiological vulnerability to&nbsp;cerebrospinal fluid (CSF) leakage.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ignoring these factors can lead to severe morbidity and dissatisfaction, as well as long-term complications.&nbsp;<sup>4\u20137<\/sup>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>a. Pregnant women:<\/strong>They are at particularly high-risk because of their\u00a0young age, female gender, and the frequent use of neuraxial\u00a0anaesthesia.Their high\u00a0oestrogen\u00a0levels influence cerebral vascular tone, increasing vascular distension in response to CSF hypotension.\u00a0<sup>6\u20137<\/sup>\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>b. Children:&nbsp;<\/strong>They are at greater risk of&nbsp;cerebrospinal fluid (CSF) leakage&nbsp;because their anatomy is much smaller. Consequently, the exact size and design of the needle remain&nbsp;critical&nbsp;determinants of risk in the&nbsp;paediatric&nbsp;population.&nbsp;<sup>3\u20134<\/sup>&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>c. Elderly patients:&nbsp;<\/strong>Their risk is often underestimated, but they face greater vulnerability to severe neurological complications if&nbsp;Post-Dural Puncture Headache (PDPH)&nbsp;becomes chronic. Furthermore, age-related spinal deformities make needle insertion more challenging, increasing the number of puncture attempts.&nbsp;<sup>4\u20136<\/sup>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>d. Low&nbsp;Body&nbsp;Mass Index (BMI):&nbsp;<\/strong>A low&nbsp;Body&nbsp;Mass Index is independently associated with an increased risk of&nbsp;Post-Dural Puncture Headache (PDPH). This is&nbsp;due to reduced epidural pressure and a diminished natural plugging effect on&nbsp;cerebrospinal fluid (CSF)&nbsp;leakage&nbsp;into the epidural space.&nbsp;<sup>4\u20136<\/sup>&nbsp;<\/p>\n\n\n\n<figure data-wp-context=\"{&quot;imageId&quot;:&quot;6a15e1abbe5c6&quot;}\" data-wp-interactive=\"core\/image\" data-wp-key=\"6a15e1abbe5c6\" class=\"wp-block-image aligncenter size-large is-resized wp-lightbox-container\"><img loading=\"lazy\" decoding=\"async\" width=\"819\" height=\"1024\" data-wp-class--hide=\"state.isContentHidden\" data-wp-class--show=\"state.isContentVisible\" data-wp-init=\"callbacks.setButtonStyles\" data-wp-on--click=\"actions.showLightbox\" data-wp-on--load=\"callbacks.setButtonStyles\" data-wp-on--pointerdown=\"actions.preloadImage\" data-wp-on--pointerenter=\"actions.preloadImageWithDelay\" data-wp-on--pointerleave=\"actions.cancelPreload\" data-wp-on-window--resize=\"callbacks.setButtonStyles\" src=\"https:\/\/campusvygon.com\/global\/wp-content\/uploads\/sites\/10\/2026\/05\/infographic-high-risk-patients-pdf-819x1024.jpg\" alt=\"Infographic titled \u201cHigh-risk patients for Post-Dural Puncture Headache (PDPH) after spinal anaesthesia: key considerations and clinical nuances.\u201d The layout lists four patient groups: pregnant women, children, elderly patients, and individuals with low body mass index (BMI). Each group is accompanied by short clinical explanations. Pregnant women are described as having frequent spinal anaesthesia exposure and increased vascular sensitivity. Children are noted to have smaller anatomy and higher risk of cerebrospinal fluid (CSF) leakage. Elderly patients are associated with spinal deformities leading to more difficult needle placement and increased puncture attempts. Low BMI is linked to reduced epidural pressure and decreased natural sealing of CSF leaks.\" class=\"wp-image-54836\" style=\"aspect-ratio:0.7998138370921964;width:713px;height:auto\" \/><button\n\t\t\tclass=\"lightbox-trigger\"\n\t\t\ttype=\"button\"\n\t\t\taria-haspopup=\"dialog\"\n\t\t\tdata-wp-bind--aria-label=\"state.thisImage.triggerButtonAriaLabel\"\n\t\t\tdata-wp-init=\"callbacks.initTriggerButton\"\n\t\t\tdata-wp-on--click=\"actions.showLightbox\"\n\t\t\tdata-wp-style--right=\"state.thisImage.buttonRight\"\n\t\t\tdata-wp-style--top=\"state.thisImage.buttonTop\"\n\t\t>\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"12\" fill=\"none\" viewBox=\"0 0 12 12\">\n\t\t\t\t<path fill=\"#fff\" d=\"M2 0a2 2 0 0 0-2 2v2h1.5V2a.5.5 0 0 1 .5-.5h2V0H2Zm2 10.5H2a.5.5 0 0 1-.5-.5V8H0v2a2 2 0 0 0 2 2h2v-1.5ZM8 12v-1.5h2a.5.5 0 0 0 .5-.5V8H12v2a2 2 0 0 1-2 2H8Zm2-12a2 2 0 0 1 2 2v2h-1.5V2a.5.5 0 0 0-.5-.5H8V0h2Z\" \/>\n\t\t\t<\/svg>\n\t\t<\/button><figcaption class=\"wp-element-caption\">High\u2011Risk Patients for Post\u2011Dural Puncture Headache (PDPH) in Spinal Anaesthesia<\/figcaption><\/figure>\n\n\n\n<div class=\"wp-block-buttons is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-5249bbc0 wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/campusvygon.com\/global\/?post_type=project&amp;p=54864\" target=\"_blank\" rel=\"noreferrer noopener\">Download<\/a><\/div>\n<\/div>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Practice guidelines: Technique and decision-making support<\/strong>&nbsp;<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Success in prevention lies in technique and in&nbsp;optimising&nbsp;the&nbsp;expertise&nbsp;of healthcare staff<\/strong>. Fewer puncture&nbsp;attempts&nbsp;directly equate to a lower risk of&nbsp;Post-Dural Puncture Headache (PDPH)&nbsp;and associated complications.&nbsp;<sup>6\u20139<\/sup>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If it is strictly necessary to use a&nbsp;cutting&nbsp;needle, the bevel must always be aligned parallel to the longitudinal dural&nbsp;fibres&nbsp;(especially in obstetrics) so as not to sever them.&nbsp;<sup>4-5-7<\/sup>&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>If the patient is a young or pregnant woman&nbsp;<\/strong>\u2192 Always use a pencil-point needle as a first line of&nbsp;defence.&nbsp;<sup>3<\/sup>&nbsp;<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>If anatomical abnormalities are present (e.g.&nbsp;in the elderly)&nbsp;<\/strong>\u2192 Anticipate difficult access;&nbsp;minimise&nbsp;attempts by delegating the procedure to the most experienced operator.&nbsp;<sup>6\u20139<\/sup>&nbsp;<\/li>\n<\/ul>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Conclusion: A&nbsp;patient-centred&nbsp;approach<\/strong><strong><\/strong>&nbsp;<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Post-Dural Puncture Headache (PDPH) is a&nbsp;largely <strong>preventable&nbsp;problem if the needle is selected&nbsp;appropriately&nbsp;and the puncture technique is refined<\/strong>.&nbsp;<sup>3<\/sup>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Prioritizing&nbsp;pencil&nbsp;point&nbsp;tip needles over&nbsp;cutting&nbsp;tip needles in high-risk patients is not an absolute prohibition, but a&nbsp;<strong>vital risk-reduction strategy<\/strong>.&nbsp;<sup>3<\/sup>&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The clinical&nbsp;objective&nbsp;is to reduce morbidity, improve patient satisfaction and lower the costs associated with treatments such as&nbsp;epidural blood patch (EBP).<sup>8<\/sup>&nbsp;<\/p>\n\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p class=\"wp-block-paragraph\"><strong><em>\u201cChoosing the needle is choosing patient&nbsp;<\/em><\/strong><strong>safety\u201d.<\/strong><strong><\/strong>&nbsp;<\/p>\n<\/blockquote>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Bibliography<\/strong>&nbsp;<\/h2>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li><strong>\u201cAtraumatic\u201d Sprotte needle reduces the incidence of post-lumbar puncture headaches M. Strupp, MD, O. Schueler, MD, A. Straube, MD, S. Von Stuckrad\u2013Barre, and T. Brandt, MD FRCP<\/strong><a href=\"https:\/\/doi.org\/10.1212\/WNL.57.12.2310\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>&nbsp;https:\/\/doi.org\/10.1212\/WNL.57.12.2310<\/strong><\/a>&nbsp;<\/li>\n<\/ol>\n\n\n\n<ol start=\"2\" class=\"wp-block-list\">\n<li><strong>&nbsp;<\/strong><strong>A&nbsp;randomised&nbsp;study to evaluate post-dural puncture headache following caesarean section: Comparison of median and paramedian approaches.&nbsp;<\/strong><strong><em>M S&nbsp;Uluer<\/em><\/strong><strong><em><sup>,<\/sup><\/em><\/strong><strong><em>&nbsp;M Sargin<\/em><\/strong><strong><em>,&nbsp;<\/em><\/strong><strong><em>F Akin<\/em><\/strong><strong><em><sup>,<\/sup><\/em><\/strong><strong><em>&nbsp;E&nbsp;Uluer<\/em><\/strong><strong><em>,&nbsp;<\/em><\/strong><strong><em>O Sahin<\/em><\/strong><strong><em>&nbsp;<\/em><\/strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31719278\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>https:\/\/pubmed.ncbi.nlm.nih.gov\/31719278\/<\/strong><\/a>&nbsp;<\/li>\n<\/ol>\n\n\n\n<ol start=\"3\" class=\"wp-block-list\">\n<li><strong>A study comparing 25 G Quincke and 25 G Whitacre spinal needles for post-dural puncture&nbsp;headache&nbsp;in the subarachnoid block.&nbsp;<\/strong><strong><em>Shivrambhai D Prajapati, Bhargav R. Patel, Sachinkumar S. Patel, Ankit R&nbsp;Sorathiya,&nbsp;Dixitkumar&nbsp;B.&nbsp;Modh,&nbsp;Meetkumar&nbsp;Kansagra, Jaldeep Patel.<\/em><\/strong><a href=\"https:\/\/impactfactor.org\/PDF\/IJPCR\/15\/IJPCR,Vol15,Issue7,Article5.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong><em>&nbsp;<\/em><\/strong><\/a><a href=\"https:\/\/impactfactor.org\/PDF\/IJPCR\/15\/IJPCR,Vol15,Issue7,Article5.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>https:\/\/impactfactor.org\/PDF\/IJPCR\/15\/IJPCR,Vol15,Issue7,Article5.pdf<\/strong><\/a>&nbsp;<\/li>\n<\/ol>\n\n\n\n<ol start=\"4\" class=\"wp-block-list\">\n<li><strong>Prevention and Management of Post-Dural Puncture Headache (PDPH).&nbsp;<\/strong><strong><em>Aynalem&nbsp;Befikadu, Sara Timerga, Fasil Mihretu, Fetene Siyoum and Amare&nbsp;Agmuas.<\/em><\/strong><a href=\"https:\/\/clinmedjournals.org\/articles\/ijaa\/international-journal-of-anesthetics-and-anesthesiology-ijaa-9-143.pdf?jid=ijaa\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>&nbsp;https:\/\/clinmedjournals.org\/articles\/ijaa\/international-journal-of-anesthetics-and-anesthesiology-ijaa-9-143.pdf?jid=ijaa<\/strong><\/a>&nbsp;<\/li>\n<\/ol>\n\n\n\n<ol start=\"5\" class=\"wp-block-list\">\n<li><strong>Incidence and risk factors of post-dural puncture headache: prospective cohort study design. Bedilu Girma&nbsp;Weji, Mohammed Suleiman Obsa,&nbsp;Kidest&nbsp;Getu Melese &amp; Gedion Asnake&nbsp;Azeze.<\/strong><a href=\"https:\/\/link.springer.com\/article\/10.1186\/s13741-020-00164-2\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>&nbsp;<\/strong><strong>https:\/\/link.springer.com\/article\/10.1186\/s13741-020-00164-2<\/strong><\/a>&nbsp;<\/li>\n<\/ol>\n\n\n\n<ol start=\"6\" class=\"wp-block-list\">\n<li><strong>Post-spinal puncture&nbsp;headache,&nbsp;an old problem&nbsp;and new concepts: review of articles on predisposing factors. Ali Jabbari, Ebrahim&nbsp;Alijanpour, Mehrafza Mir, Nadia Bani Hashem, Seyed Mozaffar Rabiea, Mohammad Ali Rupani.<\/strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24009943\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>&nbsp;<\/strong><strong>https:\/\/pubmed.ncbi.nlm.nih.gov\/24009943\/<\/strong><\/a>&nbsp;<\/li>\n<\/ol>\n\n\n\n<ol start=\"7\" class=\"wp-block-list\">\n<li><strong>Post-dural puncture headache. Kyung-Hwa Kwak.<\/strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28367283\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>&nbsp;<\/strong><strong>https:\/\/pubmed.ncbi.nlm.nih.gov\/28367283\/<\/strong><\/a>&nbsp;<\/li>\n<\/ol>\n\n\n\n<ol start=\"8\" class=\"wp-block-list\">\n<li><strong>The effect of spinal needle type on post-dural puncture headache in spinal&nbsp;anaesthesia: Prospective&nbsp;randomised&nbsp;study. Duygu Akyol, Mine \u00c7elik, Necmiye Ay, G\u00fcne\u015f \u00d6zlem Y\u0131ld\u0131z.<\/strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39128075\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>&nbsp;https:\/\/pubmed.ncbi.nlm.nih.gov\/39128075\/<\/strong><\/a>&nbsp;<\/li>\n<\/ol>\n\n\n\n<ol start=\"9\" class=\"wp-block-list\">\n<li><strong>Incidence and Factors Associated with&nbsp;Postspinal&nbsp;Headache in Obstetric Mothers Who Underwent Spinal&nbsp;Anaesthesia&nbsp;at a Tertiary Hospital in Western Uganda: A Prospective Cohort Study. Mohamud Jelle Osman, Joy Muhumuza, Yarine Fajardo, Andrew Kwikiriza, Baluku&nbsp;Asanairi, Rogers Kajabwangu, Marie Pascaline Sabine Ishimwe,&nbsp;Theoneste&nbsp;Hakizimana.<\/strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37599669\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>&nbsp;<\/strong><\/a><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37599669\/\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>https:\/\/pubmed.ncbi.nlm.nih.gov\/37599669\/<\/strong><\/a><\/li>\n<\/ol>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This image reflects the complexity of spinal anaesthesia in real clinical practice, where decisions must be made quickly, yet carefully. Identifying high\u2011risk patients and adapting the approach accordingly can significantly reduce complications and improve recovery outcomes.<br \/>\nUnderstanding the interaction between patient factors, needle design, and operator expertise is key to delivering safer, more effective care.<\/p>\n","protected":false},"author":141,"featured_media":54847,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[919],"tags":[1113,1364],"class_list":["post-54826","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-anaesthesia-and-intensive-care","tag-anesthesia","tag-needles"],"acf":[],"_links":{"self":[{"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/posts\/54826","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/users\/141"}],"replies":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/comments?post=54826"}],"version-history":[{"count":19,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/posts\/54826\/revisions"}],"predecessor-version":[{"id":54916,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/posts\/54826\/revisions\/54916"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/media\/54847"}],"wp:attachment":[{"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/media?parent=54826"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/categories?post=54826"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/campusvygon.com\/global\/wp-json\/wp\/v2\/tags?post=54826"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}