Obstetric Anaesthesia Annual Scientific Meeting 2026

EPIDURAL NEEDLES SIZES IN THE UK AND REST OF THE WORLD

Fooks P, Harrison J, Luther D

Introduction

In the UK, approximately 30% in labour receive an epidural¹. 1-2 in 100 of these women will develop a headache as result of dural puncture, with the potential for long term sequalae. 56% of these women still have a headache at six months². There is evidence a smaller epidural needle (i.e. 18G over 16G) may reduce the risk of post dural puncture headache³. However, In 2008 Katawala and Yentis showed from sales data that the majority of epidurals in the UK are carried out with a 16G Touhy needle in contrast to the rest of the world where 18G is more common⁴

Aim
We sought to characterize up to date global sales data to determine whether the UK remains an outlier in its use of 16 gauge epidural needles

Why
Retrospective data collection studies have indicated a potential benefit when using 18G needles on the risk of PDPH³. The UK has traditionally used 16G needles though a minority of centres have adopted smaller 18G needles⁴ as their default. The most recent data we found to be available was over 15 years old and may not reflect current practice.

Methods
Methods-Email requests for data were sent to the 3 largest producers of epidural kits in the UK (Smiths-Portex®, Pajunk®, Braun®)-We requested sales data by regions throughout the globe

Results
2/3 manufacturers responded (Pajunk® & Braun®), covering ~50% of UK/European and ~25% of global sales UK: 1

6G dominates — 84% of sales (Braun® 2025 & Pajunk® 2024)

Europe: 16G is rare — only 5.4% (Braun®) and 0.3% (Pajunk®)

USA: 17G leads — 56% of Braun®'s North American sales

Rest of world: 18G dominates — >75% of sales outside UK & North America

Discussion
Global divide: The UK predominantly purchases 16G epidural kits, The US 17G and the rest of the world 18G

Trends: No shift in UK or European trends since 2008. Though we note in 2011 Sadashivaiah and Yentis discovered that 75% of UK sales were 16G, perhaps reflecting a resistance to switching to 18G

Limitations included limtied coverage (50% UK/25% global). Also, Sales data ≠ usage data - No information on how epidurals are used e.g. labour, abdominal surgery, chronic pain procedures

Conclusion
• Variable needle choice by region: Needle choice varies throughout the world

• UK Predominantly opts for 16G epidural needles,

• US takes the middle ground with 17G

• Rest of the World predominantly uses 18G

• Further data specific to labour epidurals would characterise UK data more clearly but is unlikely necessary given the clear divide

• UK sales remain dominated by 16G despite evidence suggesting smaller gauges may lower PDPH

References

1)Ronel I, Weiniger C. Non-regional analgesia for labour: remifentanil in obstetrics. BJA Education, 2019; 19, 357-361

2)Ansari J et al. Chronic disabling postpartum headache after unintentional dural puncture during epidural anaesthesia: a prospective cohort study. British Journal of Anaesthesia, 2021; 127, 600-607

3)Sadashivaiah J, McLure H. 18-G Tuohy needle can reduce the incidence of severe post dural puncture headache. Anaesthesia. 2009;64(12):1379-1380. 5) Guathama P, Mushambi M, Francis S. National survey on epidural needle size used in obstetric practice. International Journal of Obstetric Anaesthesia. 2011; 20: S19.

4)Katawala T, Yentis SM. Epidural needle sizes in the UK and rest of the world. International Journal of Obstetric Anaesthesia 2008; 17: S26.

Obstetric Anaesthesia Annual Scientific Meeting 2026

Epidural needle sizes in the UK and the rest of the world

Poster Presenter

Authors

Affiliations

Part of Topic