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Previous pairwise meta\u2010analyses have either compared groups of needles or ranked individual needles based on the pooled incidence of post\u2010dural puncture headache. These analyses have suggested both the gauge and needle tip design as risk\u2010factors, but failed to provide an unbiased comparison of individual needles. This network meta\u2010analysis compared the odds of post\u2010dural puncture headache with needles of varying gauge and tip design. We searched randomised controlled trials in medical databases. The primary outcome measure of the network meta\u2010analysis was the incidence of post\u2010dural puncture headache. Secondary outcomes were procedural failure, backache and non\u2010specific headache. Overall, we compared 11 different needles in 61 randomised controlled trials including a total of 14,961 participants. The probability of post\u2010dural puncture headache and procedural failure was lowest with 26\u2010G atraumatic needles. The 29\u2010G cutting needle was more likely than three atraumatic needles to have the lowest odds of post\u2010dural puncture headache, although with increased risk of procedural failure. The probability rankings were: 26 atraumatic\u00a0&gt;\u00a027 atraumatic\u00a0&gt;\u00a029 cutting\u00a0&gt;\u00a024 atraumatic\u00a0&gt;\u00a022 atraumatic\u00a0&gt;\u00a025 atraumatic\u00a0&gt;\u00a023 cutting\u00a0&gt;\u00a022 cutting\u00a0&gt;\u00a025 cutting\u00a0&gt;\u00a027 cutting\u00a0=\u00a026 cutting for post\u2010dural puncture headache; and 26 atraumatic\u00a0&gt;\u00a025 cutting\u00a0&gt;\u00a022 cutting\u00a0&gt;\u00a024 atraumatic\u00a0&gt;\u00a022 atraumatic\u00a0&gt;\u00a025 atraumatic\u00a0&gt;\u00a026 cutting\u00a0&gt;\u00a029 cutting\u00a0&gt;\u00a027 atraumatic\u00a0=\u00a027 cutting for procedural success. Meta\u2010regression by type of surgical population (obstetric\/non\u2010obstetric) and participant position (sitting\/lateral) did not alter these rank orders. This analysis provides an unbiased comparison of individual needles that does not support the use of simple rules when selecting the optimal needle. The 26\u2010G atraumatic needle is most likely to enable successful insertion while avoiding post\u2010dural puncture headache but, where this is not available, our probability rankings can help clinicians select the best of available options.<\/jats:p>","DOI":"10.1111\/anae.15320","type":"journal-article","created":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T05:56:32Z","timestamp":1608270992000},"page":"1098-1110","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["The association between post\u2010dural puncture headache and needle type during spinal anaesthesia: a systematic review and network meta\u2010analysis"],"prefix":"10.1111","volume":"76","author":[{"given":"B.","family":"Maranhao","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology Washington University in Saint Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Washington University in Saint Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Palanisamy","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Washington University in Saint Louis MO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. 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