Comparison of Post-Operative Complications Between Sharp and Cutting Spinal Needle in Patients Undergoing Lower Limb Surgeries

Abstract

Background: Post-dural puncture headache (PDPH) remains a common and distressing complication of spinal anesthesia, influenced significantly by the design of the spinal needle. While non-cutting (pencil-point) needles have been associated with reduced dural trauma and lower PDPH incidence, their adoption in clinical practice varies, particularly in resource-limited settings. Understanding how needle type impacts postoperative outcomes is critical for optimizing spinal anesthesia safety and efficacy. Objective: To compare the incidence of postoperative complications, particularly PDPH, between patients receiving spinal anesthesia with cutting versus non-cutting spinal needles during lower limb surgeries. Methods: A comparative cross-sectional study was conducted over four months in three tertiary hospitals in Lahore, enrolling 80 adult patients aged 20–60 years undergoing lower limb surgeries under spinal anesthesia. Patients were grouped based on the needle type used—cutting (n=44) or pencil-point (n=36). Data on demographics, procedural details, number of attempts, and postoperative complications were collected via structured questionnaires and analyzed using SPSS. Inferential statistics included chi-square tests and odds ratios with 95% confidence intervals. Results: PDPH occurred in 70.5% of patients receiving cutting needles compared to 33.3% with pencil-point needles (p=0.001, 5.06 [2.00–12.8]). Early onset PDPH (<12 hours) was significantly more frequent in the cutting group (40.9% vs. 11.1%, p=0.001). Repeated attempts and prior PDPH history were additional risk factors. Conclusion: Non-cutting spinal needles significantly reduce PDPH incidence and related complications. Preference for pencil-point designs and minimizing multiple attempts can improve patient safety and procedural outcomes in spinal anaesthesia.