Pub Date : 2026-01-30DOI: 10.1016/j.ijoa.2026.104870
Mohamed Iraqy, Halla Tarakemah, Mohamed Heyba, Ahmed Mahmoud, Ahmed Haggag, Abdelrady Ibrahim, Fatemah Qasem
Background: Spinal needle fracture during spinal anaesthesia is a rare but potentially serious complication, particularly in obstetric practice where neuraxial techniques are frequently used. We report a series of three cases of spinal needle fracture during attempted spinal anaesthesia for caesarean delivery and describe a common technical mechanism and management approach.
Case series: Three patients with obesity had an attempted spinal anaesthetic for caesarean delivery with a fine-gauge pencil-point spinal needle through an introducer. In all cases, fracture occurred during needle redirection while the introducer remained stationary. The neuraxial attempt was abandoned and caesarean delivery proceeded under general anaesthesia in all three cases. Postpartum imaging with computed tomography was used to localise the retained fragments, which were subsequently removed surgically. Neurologic assessment during admission and follow-up at two weeks and one month demonstrated no neurologic deficits in any patient.
Conclusion: Spinal needle fracture can occur when redirection of a fine spinal needle is attempted through a fixed introducer. Awareness of this mechanism, careful technique, and early imaging are essential to reduce risk and guide management in this rare complication.
{"title":"Spinal needle fracture during attempted spinal anaesthesia for caesarean delivery: a series of three cases.","authors":"Mohamed Iraqy, Halla Tarakemah, Mohamed Heyba, Ahmed Mahmoud, Ahmed Haggag, Abdelrady Ibrahim, Fatemah Qasem","doi":"10.1016/j.ijoa.2026.104870","DOIUrl":"https://doi.org/10.1016/j.ijoa.2026.104870","url":null,"abstract":"<p><strong>Background: </strong>Spinal needle fracture during spinal anaesthesia is a rare but potentially serious complication, particularly in obstetric practice where neuraxial techniques are frequently used. We report a series of three cases of spinal needle fracture during attempted spinal anaesthesia for caesarean delivery and describe a common technical mechanism and management approach.</p><p><strong>Case series: </strong>Three patients with obesity had an attempted spinal anaesthetic for caesarean delivery with a fine-gauge pencil-point spinal needle through an introducer. In all cases, fracture occurred during needle redirection while the introducer remained stationary. The neuraxial attempt was abandoned and caesarean delivery proceeded under general anaesthesia in all three cases. Postpartum imaging with computed tomography was used to localise the retained fragments, which were subsequently removed surgically. Neurologic assessment during admission and follow-up at two weeks and one month demonstrated no neurologic deficits in any patient.</p><p><strong>Conclusion: </strong>Spinal needle fracture can occur when redirection of a fine spinal needle is attempted through a fixed introducer. Awareness of this mechanism, careful technique, and early imaging are essential to reduce risk and guide management in this rare complication.</p>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"104870"},"PeriodicalIF":2.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1016/j.ijoa.2026.104865
O D Thomas, R Hansell, E Hughes, J Reid, S Jones, R E Collis, S F Bell, L de Lloyd
Introduction: Optimal fluid resuscitation strategies in PPH are unknown. This planned secondary analysis describes fluid resuscitation during OBS Plus, a study designed to characterise PPH coagulopathy. The hypothesis was that the volume of fluid resuscitation equalled the volume of blood loss. Primary outcome was the ratio of clear fluid infused: blood loss.
Methods: Patients recruited into the OBS Plus study with available fluid infusion data and measured blood loss ≥ 1000 mL were included. Clinical management was guided by a PPH care bundle incorporating bedside testing of coagulation. Fluid resuscitation was at the discretion of the clinical team. Infusions commenced 1 h before to 1 h after PPH were analysed.
Results: Between 2017 and 2019, 495 patients with PPH ≥ 1000 mL were recruited. 67/495 (13.5%) were excluded for missing data. Clear fluid infusions were crystalloid, 426/428 (99.5%) and colloid, 39/428 (9.1%). Blood product transfusions were red blood cells, 40/428 (9.4%); fresh frozen plasma 3/428 (0.7%); platelets 5/428 (1.1%). Overall median ratio clear fluids: blood loss was 858:1000 mL with blood products contributing to resuscitation volumes in massive PPH (≥ 2500 mL). Fluid volumes ≥ 3500 mL were only infused in massive PPH. No patients required renal replacement therapy or respiratory support for fluid overload.
Discussion: Inappropriate clear fluid resuscitation may cause fluid overload or renal injury. In this report, no patient required respiratory or renal support and median fluid resuscitation volume was approximately equal to blood loss. The incidence of coagulopathy in OBS Plus should be interpreted in this context.
{"title":"Fluid infusion during postpartum hemorrhage: a secondary analysis of the Obstetric Bleeding Study (OBS) Plus prospective observational study.","authors":"O D Thomas, R Hansell, E Hughes, J Reid, S Jones, R E Collis, S F Bell, L de Lloyd","doi":"10.1016/j.ijoa.2026.104865","DOIUrl":"https://doi.org/10.1016/j.ijoa.2026.104865","url":null,"abstract":"<p><strong>Introduction: </strong>Optimal fluid resuscitation strategies in PPH are unknown. This planned secondary analysis describes fluid resuscitation during OBS Plus, a study designed to characterise PPH coagulopathy. The hypothesis was that the volume of fluid resuscitation equalled the volume of blood loss. Primary outcome was the ratio of clear fluid infused: blood loss.</p><p><strong>Methods: </strong>Patients recruited into the OBS Plus study with available fluid infusion data and measured blood loss ≥ 1000 mL were included. Clinical management was guided by a PPH care bundle incorporating bedside testing of coagulation. Fluid resuscitation was at the discretion of the clinical team. Infusions commenced 1 h before to 1 h after PPH were analysed.</p><p><strong>Results: </strong>Between 2017 and 2019, 495 patients with PPH ≥ 1000 mL were recruited. 67/495 (13.5%) were excluded for missing data. Clear fluid infusions were crystalloid, 426/428 (99.5%) and colloid, 39/428 (9.1%). Blood product transfusions were red blood cells, 40/428 (9.4%); fresh frozen plasma 3/428 (0.7%); platelets 5/428 (1.1%). Overall median ratio clear fluids: blood loss was 858:1000 mL with blood products contributing to resuscitation volumes in massive PPH (≥ 2500 mL). Fluid volumes ≥ 3500 mL were only infused in massive PPH. No patients required renal replacement therapy or respiratory support for fluid overload.</p><p><strong>Discussion: </strong>Inappropriate clear fluid resuscitation may cause fluid overload or renal injury. In this report, no patient required respiratory or renal support and median fluid resuscitation volume was approximately equal to blood loss. The incidence of coagulopathy in OBS Plus should be interpreted in this context.</p>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"104865"},"PeriodicalIF":2.3,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21DOI: 10.1016/j.ijoa.2026.104863
Patricia Duch , Helene K. Nedergaard , Christoffer C. Jørgensen
Background
Severe postoperative pain after caesarean delivery may delay recovery by impeding mobilisation and activities of daily living and may also interfere with feeding and caregiving of the infant. This study aimed to describe maternal recovery after caesarean delivery and investigate the association between severe pain within the first 24 h after surgery and impaired mobilisation, breastfeeding, and overall quality of recovery.
Methods
This is a planned secondary analysis on a nationwide prospective cohort study across 19 centers in Denmark, with repeated patient-reported outcomes collected throughout the early postoperative hours and days postpartum, analysing recovery outcomes using multivariable regression and multiple imputation for missing data.
Results
Of 583 included patients, 64.6% reported severe pain (numeric rating scale ≥ 7) within the initial 24 h after caesarean delivery. The mean recovery score (ObsQoR-10, range 0–100) was 59.13 ± 13.0 vs. 70.55 ± 12.8 (adjusted difference −11.01, 95% CI −13.40 to −8.62; P < 0.001) in patients with vs. without severe pain, respectively. Severe pain was associated with reduced likelihood of walking independently (86% vs. 94%, adjusted OR 0.43, 95% CI 0.2 to 0.9; P = 0.030), and ability to independently breastfeed (65% vs. 75%, adjusted OR 0.61, 95% CI 0.4 to 0.9; P = 0.037) 24 h after caesarean delivery.
Conclusions
Severe pain during the first 24 h after caesarean delivery is associated with significant and clinically relevant impaired patient-reported outcome measures of recovery, mobilisation and breastfeeding. These findings support the importance of adequate post-caesarean analgesia for improving maternal recovery.
背景：剖宫产后严重的术后疼痛可能会阻碍活动和日常生活活动，从而延迟恢复，也可能影响婴儿的喂养和护理。本研究旨在描述剖宫产后产妇的恢复情况，并调查术后24小时内剧烈疼痛与活动能力受损、母乳喂养和整体恢复质量之间的关系。方法：这是一项针对丹麦19个中心的全国性前瞻性队列研究的计划二级分析，在术后早期和产后几天内收集重复的患者报告结果，使用多变量回归和对缺失数据的多重代入分析恢复结果。结果583例纳入的患者中，64.6%的患者在剖宫产后最初24小时内报告了剧烈疼痛（数值评定量表≥7）。有无剧烈疼痛患者的平均恢复评分（ObsQoR-10，范围0-100）分别为59.13±13.0和70.55±12.8（校正差为- 11.01,95% CI为- 13.40至- 8.62;P < 0.001）。严重疼痛与剖宫产后24小时独立行走可能性降低（86%对94%，校正OR 0.43, 95% CI 0.2 ~ 0.9; P = 0.030）和独立母乳喂养能力降低（65%对75%，校正OR 0.61, 95% CI 0.4 ~ 0.9; P = 0.037）相关。结论：剖宫产后24小时内的剧烈疼痛与患者报告的恢复、活动和母乳喂养的预后指标明显受损相关。这些发现支持充分的剖腹产后镇痛对改善产妇康复的重要性。
{"title":"Mobilisation, breastfeeding, and quality of recovery after caesarean delivery: a nationwide prospective cohort study in Denmark with secondary analysis on the association with severe pain","authors":"Patricia Duch , Helene K. Nedergaard , Christoffer C. Jørgensen","doi":"10.1016/j.ijoa.2026.104863","DOIUrl":"10.1016/j.ijoa.2026.104863","url":null,"abstract":"<div><h3>Background</h3><div>Severe postoperative pain after caesarean delivery may delay recovery by impeding mobilisation and activities of daily living and may also interfere with feeding and caregiving of the infant. This study aimed to describe maternal recovery after caesarean delivery and investigate the association between severe pain within the first 24 h after surgery and impaired mobilisation, breastfeeding, and overall quality of recovery.</div></div><div><h3>Methods</h3><div>This is a planned secondary analysis on a nationwide prospective cohort study across 19 centers in Denmark, with repeated patient-reported outcomes collected throughout the early postoperative hours and days postpartum, analysing recovery outcomes using multivariable regression and multiple imputation for missing data.</div></div><div><h3>Results</h3><div>Of 583 included patients, 64.6% reported severe pain (numeric rating scale ≥ 7) within the initial 24 h after caesarean delivery. The mean recovery score (ObsQoR-10, range 0–100) was 59.13 ± 13.0 vs. 70.55 ± 12.8 (adjusted difference −11.01, 95% CI −13.40 to −8.62; <em>P</em> < 0.001) in patients with vs. without severe pain, respectively. Severe pain was associated with reduced likelihood of walking independently (86% vs. 94%, adjusted OR 0.43, 95% CI 0.2 to 0.9; <em>P</em> = 0.030), and ability to independently breastfeed (65% vs. 75%, adjusted OR 0.61, 95% CI 0.4 to 0.9; <em>P</em> = 0.037) 24 h after caesarean delivery.</div></div><div><h3>Conclusions</h3><div>Severe pain during the first 24 h after caesarean delivery is associated with significant and clinically relevant impaired patient-reported outcome measures of recovery, mobilisation and breastfeeding. These findings support the importance of adequate post-caesarean analgesia for improving maternal recovery.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104863"},"PeriodicalIF":2.3,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20DOI: 10.1016/j.ijoa.2026.104854
Daniel F. Berenson, William R. Camann
{"title":"In response to “Dexmedetomidine for cesarean delivery: clinical enthusiasm, limited evidence”","authors":"Daniel F. Berenson, William R. Camann","doi":"10.1016/j.ijoa.2026.104854","DOIUrl":"10.1016/j.ijoa.2026.104854","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104854"},"PeriodicalIF":2.3,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146036091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20DOI: 10.1016/j.ijoa.2026.104853
Mina Adolf Helmy, Lydia Magdy Milad
{"title":"In response to “Cardiac ultrasound-guided crystalloid preloading before spinal anesthesia vs. standard coloading for scheduled cesarean delivery: a randomized controlled trial”","authors":"Mina Adolf Helmy, Lydia Magdy Milad","doi":"10.1016/j.ijoa.2026.104853","DOIUrl":"10.1016/j.ijoa.2026.104853","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104853"},"PeriodicalIF":2.3,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146036090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-19DOI: 10.1016/j.ijoa.2026.104852
P.E. Hess, Y. Li
{"title":"“Dexmedetomidine for cesarean delivery: clinical enthusiasm, limited evidence”: this Editorial should be a call to action","authors":"P.E. Hess, Y. Li","doi":"10.1016/j.ijoa.2026.104852","DOIUrl":"10.1016/j.ijoa.2026.104852","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104852"},"PeriodicalIF":2.3,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146036092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.ijoa.2026.104850
S. Ayoub, N. Pate, J. Sheeran
Respecting patient autonomy can present complex challenges in obstetric anesthesia, particularly when a mother desires safe maternal-fetal care but is unable to cooperate due to psychological barriers. The Ulysses contract is a framework that allows patients to consent to treatment in advance if they are to lack decision making capacity later. This case illustrates a unique implementation of the Ulysses contract in an obstetric patient in which involvement of early multidisciplinary support was paramount to allow safe and timely medical care that aligned with the patient’s wishes.
{"title":"Implementation of the Ulysses contract in a patient with severe needle phobia: a case report","authors":"S. Ayoub, N. Pate, J. Sheeran","doi":"10.1016/j.ijoa.2026.104850","DOIUrl":"10.1016/j.ijoa.2026.104850","url":null,"abstract":"<div><div>Respecting patient autonomy can present complex challenges in obstetric anesthesia, particularly when a mother desires safe maternal-fetal care but is unable to cooperate due to psychological barriers. The Ulysses contract is a framework that allows patients to consent to treatment in advance if they are to lack decision making capacity later. This case illustrates a unique implementation of the Ulysses contract in an obstetric patient in which involvement of early multidisciplinary support was paramount to allow safe and timely medical care that aligned with the patient’s wishes.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104850"},"PeriodicalIF":2.3,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.ijoa.2026.104851
William Turner , Kat Butler , Nuala Coyle
Background
Transgender and gender-diverse individuals are increasingly accessing obstetric services, yet evidence relating to their intrapartum care remains limited. This study surveyed obstetric anaesthetists practising in the United Kingdom (UK) to explore experience, training, departmental policies, and perspectives on language and care.
Methods
An anonymous thirteen-question online survey was distributed to members of the Obstetric Anaesthetists’ Association (OAA) in June 2025. Quantitative responses were summarised descriptively, and free-text responses were reviewed by recurring topics.
Results
The response rate was low (13.7%) and a total of 262 responses were analysed. Most respondents were consultants, and nearly half had more than ten years’ experience. Formal training was uncommon, and almost half reported never providing intrapartum care to a transgender patient. Few reported departmental policies, and comfort levels varied. Most believed inclusive language improved care.
Conclusions
This survey of UK-based OAA members demonstrated gaps in experience, and systems support for transgender and gender-diverse intrapartum care, and lack of training in transgender obstetric anaesthesia care, alongside the importance of respectful, patient-centred communication.
{"title":"Intrapartum care for transgender and gender-diverse individuals: an Obstetric Anaesthetists Association (OAA) members’ perspective survey (2025)","authors":"William Turner , Kat Butler , Nuala Coyle","doi":"10.1016/j.ijoa.2026.104851","DOIUrl":"10.1016/j.ijoa.2026.104851","url":null,"abstract":"<div><h3>Background</h3><div>Transgender and gender-diverse individuals are increasingly accessing obstetric services, yet evidence relating to their intrapartum care remains limited. This study surveyed obstetric anaesthetists practising in the United Kingdom (UK) to explore experience, training, departmental policies, and perspectives on language and care.</div></div><div><h3>Methods</h3><div>An anonymous thirteen-question online survey was distributed to members of the Obstetric Anaesthetists’ Association (OAA) in June 2025. Quantitative responses were summarised descriptively, and free-text responses were reviewed by recurring topics.</div></div><div><h3>Results</h3><div>The response rate was low (13.7%) and a total of 262 responses were analysed. Most respondents were consultants, and nearly half had more than ten years’ experience. Formal training was uncommon, and almost half reported never providing intrapartum care to a transgender patient. Few reported departmental policies, and comfort levels varied. Most believed inclusive language improved care.</div></div><div><h3>Conclusions</h3><div>This survey of UK-based OAA members demonstrated gaps in experience, and systems support for transgender and gender-diverse intrapartum care, and lack of training in transgender obstetric anaesthesia care, alongside the importance of respectful, patient-centred communication.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104851"},"PeriodicalIF":2.3,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-10DOI: 10.1016/j.ijoa.2026.104848
Megan Glynn , Rosemarie Kearsley
{"title":"Letter to the Editor ‘Anaesthetic considerations for delivery in an obstetric patient with a RYR1 gene variant: a case report’","authors":"Megan Glynn , Rosemarie Kearsley","doi":"10.1016/j.ijoa.2026.104848","DOIUrl":"10.1016/j.ijoa.2026.104848","url":null,"abstract":"","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104848"},"PeriodicalIF":2.3,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-10DOI: 10.1016/j.ijoa.2026.104849
M. Balot, G. Echevarria, A. Lee, B. Mahoney
Background
Combined spinal epidural (CSE) and dural puncture epidural (DPE) procedures have become increasingly utilized for labor analgesia, though no standards exist on which spinal needle to use. It has been demonstrated that pencil-point needles reduce the rate of postdural puncture headaches; however, there is no consensus on the optimal size to minimize headache risk while maximizing analgesia.
Methods
A single-center retrospective cohort study was conducted of parturients receiving CSE or DPE for neuraxial labor analgesia between 2018 and 2023 to identify the postdural puncture headache rate with intended (but not unintended) dural puncture.
Results
A total of 10,459 CSE and DPE procedures were performed during the study period, with CSE most commonly performed (91%). For CSE, 27G needle was used in 69% of cases, and for DPE, 25G needle was used in nearly two-thirds of cases. Fifty-four patients (0.52%) experienced a postdural puncture headache (without evidence of unintended dural puncture with epidural needle). Postdural puncture headache occurred more frequently with 25G needles than with 27G needles (0.73% vs. 0.41%), corresponding to a risk ratio of 0.56 (95% CI 0.34–0.92; P=0.029)).
Conclusions
There was a small but statistically significant increase in the incidence of postdural puncture headache when comparing rates with use of 25G vs. 27G needles during CSE or DPE. However, the clinical significance of this modest increase must be weighed against the potential benefit of improved analgesia with the use of larger-gauge (25G) pencil-point spinal needles.
背景：脊髓硬膜外穿刺术（CSE）和硬膜外穿刺术（DPE）已越来越多地用于分娩镇痛，尽管没有标准的脊髓针的使用。研究表明，铅笔针可以降低硬脊膜穿刺后头痛的发生率；然而，对于最小化头痛风险同时最大化止痛效果的最佳尺寸尚无共识。方法采用单中心回顾性队列研究，对2018 - 2023年接受CSE或DPE进行轴向分娩镇痛的产妇进行研究，以确定有意（非意外）硬脊膜穿刺后头痛发生率。结果在研究期间共进行了10459例CSE和DPE手术，其中以CSE手术最为常见（91%）。对于CSE， 69%的病例使用27G针头，对于DPE，近三分之二的病例使用25G针头。54例（0.52%）患者出现硬膜穿刺后头痛（无硬膜外穿刺针意外穿刺）。25G针头比27G针头更容易发生硬脊膜后穿刺头痛（0.73% vs. 0.41%），相应的风险比为0.56 （95% CI 0.34-0.92； P=0.029）。结论：在CSE或DPE中，25G针与27G针的发生率相比，硬脊膜后穿刺头痛的发生率略有增加，但有统计学意义。然而，这种适度增加的临床意义必须与使用更大口径（25G）铅笔尖脊柱针改善镇痛的潜在益处进行权衡。
{"title":"Postdural puncture headache after neuraxial labor analgesia with 25- vs. 27-gauge Whitacre needles: a single-center retrospective cohort study (2018–2023)","authors":"M. Balot, G. Echevarria, A. Lee, B. Mahoney","doi":"10.1016/j.ijoa.2026.104849","DOIUrl":"10.1016/j.ijoa.2026.104849","url":null,"abstract":"<div><h3>Background</h3><div>Combined spinal epidural (CSE) and dural puncture epidural (DPE) procedures have become increasingly utilized for labor analgesia, though no standards exist on which spinal needle to use. It has been demonstrated that pencil-point needles reduce the rate of postdural puncture headaches; however, there is no consensus on the optimal size to minimize headache risk while maximizing analgesia.</div></div><div><h3>Methods</h3><div>A single-center retrospective cohort study was conducted of parturients receiving CSE or DPE for neuraxial labor analgesia between 2018 and 2023 to identify the postdural puncture headache rate with intended (but not unintended) dural puncture.</div></div><div><h3>Results</h3><div>A total of 10,459 CSE and DPE procedures were performed during the study period, with CSE most commonly performed (91%). For CSE, 27G needle was used in 69% of cases, and for DPE, 25G needle was used in nearly two-thirds of cases. Fifty-four patients (0.52%) experienced a postdural puncture headache (without evidence of unintended dural puncture with epidural needle). Postdural puncture headache occurred more frequently with 25G needles than with 27G needles (0.73% vs. 0.41%), corresponding to a risk ratio of 0.56 (95% CI 0.34–0.92; <em>P</em>=0.029)).</div></div><div><h3>Conclusions</h3><div>There was a small but statistically significant increase in the incidence of postdural puncture headache when comparing rates with use of 25G vs. 27G needles during CSE or DPE. However, the clinical significance of this modest increase must be weighed against the potential benefit of improved analgesia with the use of larger-gauge (25G) pencil-point spinal needles.</div></div>","PeriodicalId":14250,"journal":{"name":"International journal of obstetric anesthesia","volume":"66 ","pages":"Article 104849"},"PeriodicalIF":2.3,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145981472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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