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Postdural puncture headache and needle size

Multicentred RCT comparing the impact of using 19g vs. >18g epidural needles on the incidence of postdural puncture headache: study in progress

Postdural puncture headache is the most common significant complication of epidural placement. Many women experience moderate to severe postdural headaches that can last for a week or longer. These headaches occur if the epidural needle inadvertently punctures the dural sac, the fluid-filled sac that surrounds the brain and spinal cord. Use of smaller needles during spinal anesthesia has been found to reduce the risk of postdural headaches from about 30% to less than 2%.

Dr. Pamela Angle and her colleagues conducted preliminary research using a smaller epidural needle (currently used in some hospitals for children and for epidural steroid injections) and a smaller catheter for labour pain relief. The results of the first cohort study showed good to excellent pain control in most of the women studied, and a mild headache in only one of them.

These findings led to the current randomized controlled trial examining the effect on headache of using the smaller epidural needle and catheter versus the traditional larger epidural needle. Participating hospitals include sites in Ontario (Toronto and London), Nova Scotia (Halifax) and British Columbia (Vancouver). Other outcomes examined will include differences in headache severity, duration, treatability and quality of life between groups.

Principal investigator:

Co-investigators:

Study site and study coordinating centre:

  • Sunnybrook Health Sciences Centre housed at Women's College Hospital

Trial coordinator:

  • Jennifer Yee

Research assistant:

  • Michele Haley

Collaborating centres:

  • Drs. Dolores McKeen and Ron George
    IWK Hospital, Halifax
  • Drs. Joanne Douglas and Roanne Preston
    BC Women's Hospital, Vancouver
  • Drs. Indu Singh and Shalini Dhir
    St. Joseph's Hospital, London

Funded by:

  • Physicians' Services Inc. Foundation: $149,500 (March 1, 2007 to March 1, 2009)
  • RA Gordon Patient Safety Award, Canadian Anesthesiologists' Society: $40,000 (July 1, 2007 to July 1, 2008)
  • Women's College Research Institute: Women's Health Summer Experience Student Funding Award (May to August 2008)

Status:

We are actively recruiting labouring women who desire epidural pain relief for labour.

Target sample size:

3,100 (about 1,000 women randomized as of June 2009)

To join this study:

Contact Jennifer Yee at 416-323-6400, ext. 2742

More information:

There is also general information available about participating in clinical trials.