• Pamela J Angle, Kamal Hussain, Anwar Morgan, Stephen H Halpern, Martin Van der Vyver, Jennifer Yee, and Alexander Kiss.
• Department of Anesthesia, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario M5S 1B2, Canada. pamela.angle@sw.ca
• Can J Anaesth. 2006 Mar 1;53(3):263-7.

PurposeInadvertent epidural needle punctures represent the leading cause of severe postdural puncture headache (PDPH) in parturients. Use of small gauge (G) epidural needles for continuous analgesia has received little attention despite possible important reductions in PDPH. We report the first study to examine the feasibility of using small G Tuohy needles and 23 G catheters for labour analgesia.MethodsHealthy parturients 30 min), recognized dural puncture, PDPH, patient assessment of analgesia within 24 hr of delivery, complications and anesthesiologist satisfaction.ResultsTwenty-seven parturients were recruited. Successful blocks were initiated and maintained in 24/27 who rated overall analgesia from good to excellent (19/24 very good to excellent). Three block failures occurred at the initiation phase only (two unilateral, one absent). There was no evidence of catheter kinking after placement. One patient developed PDPH after unrecognized dural puncture which was self-treated with acetaminophen for four days, followed by complete symptom resolution.ConclusionIt is feasible to provide high quality labour analgesia using small G epidural needles and catheters. The effect of small G epidural needles on PDPH warrants future study.

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