Reg Anesth Pain Med 2017 Nov/Dec;42(6):709-718
From the *Department of Clinical Medical Sciences, CEU San Pablo University School of Medicine; and †Department of Anesthesiology, Madrid-Montepríncipe University Hospital, Madrid; ‡Laboratory of Surgical NeuroAnatomy, Human Anatomy and Embryology Unit, Faculty of Medicine, Universitat de Barcelona, Barcelona; and §Antón Borja Primary Care Centre, Terrassa Health Consortium, Rubí, Spain; ∥Department of Anesthesia, Royal Hospital for Women & Prince of Wales & Sydney Children's Hospitals, Randwick & University of New South Wales, Kensington, Sydney, New South Wales, Australia; **Department of Anesthesia Critical care and Pain Management, General University Hospital, Valencia and Department of Surgical Specialties, School of Medicine, Valencia University, Valencia; and ††Laboratory of Surgical NeuroAnatomy, Human Anatomy and Embryology Unit, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain; and ‡‡Department of Anesthesiology & Perioperative Medicine, The University of Queensland & Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.
: It has been customary to attribute postdural puncture headache (PDPH) incidence and severity to size and nature of the dural hole produced during major neuraxial blockade or diagnostic dural puncture. Needle orientation in relation to the direction of dural fibers was thought to be of importance because of the propensity for horizontal bevel placement to cause cutting rather than splitting of the dural fibers.Methods
: In vitro punctures of stringently quality-controlled human dural sac specimens were obtained with 27-gauge (27G) Whitacre needle (n = 33), with 29G Quincke used parallel to the spinal axis (n = 30), and with 29G Quincke in perpendicular approach (n = 40). Read More