Spinal anaesthesia for emergency caesarean section better using 25-gauge pencil point needle or 22-gauge cutting needle: a single centre prospective study

Objective: Less diameter needles may cause less side effect in lumbar anesthesia. However, some Chinese anesthesiologists consider that bigger needles are suitable for emergency surgery, because it can shorten the puncture period. Present study aimed to compare 25-gauge (G) pencil point needle with 22G cutting needle for emergency caesarean section. Methods: In this prospective study, 200 females with full-term labor were enrolled and randomly assigned to receive spinal anesthesia with either 25G pencil point needle (25P) or 22G cutting needle (22C). Subsequently, we compared the duration of spinal puncture, quality effect of analgesia and the incidence of adverse events. Results: The duration of puncture procedure was investigated in the three patients’ landmark palpation conditions: easy, moderate and difficult, respectively. The difference was no statistical significance in easy (P = 0.400) and moderate (P = 0.450), while positive (P = 0.028) when patients’ landmark was difficult for palpation. However, the absolute value of difference of the two medians was only 5.6 second due to the whole procedure is short. A 22G cutting needle was found easier at insertion. The incidence of post dural puncture headache (PDPH), effect of spinal anesthesia, neonatal Apgar scores were similar in the two groups. Conclusions: The duration of spinal procedure using 22G needle maybe save some time when patients’ landmark was difficult to palpate, but maybe only a few seconds; thus, the patients’ benefits are limited. Considering the higher PDPH incidence with the bigger needle, 25G pencil needle might be a better choice in the Spinal anesthesia for emergency caesarean section.