Postdural puncture headache: impact of needle type, a randomized trial

• Published in: The spine journal Vol. 15; no. 7; pp. 1571 - 1576
• Main Authors: Castrillo, Ana, MD, Tabernero, César, MD, García-Olmos, Luis M., MD, Gil, Cecilia, MD, Gutiérrez, Raúl, MD, Zamora, María I., MD, Mendoza, Amelia, MD, Rodríguez, María F., MD, PhD, Guerrero, Pilar, MD, Rodríguez-Vico, Jaime S., MD, Ferrero, Marta, MD, Morollón, Noemí, MD, Duarte, Jacinto, MD PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2015
• Subjects: Atraumatic; Cerebrospinal fluid; Female; Headache; Humans; Incidence; Lumbar puncture; Male; Middle Aged; Needles; Orthopedics; Post-Dural Puncture Headache - epidemiology; Post-Dural Puncture Headache - etiology; Prospective Studies; Spinal needle; Spinal Puncture - adverse effects; Spinal Puncture - instrumentation; Traumatic; Atraumatic; Headache; Traumatic; Cerebrospinal fluid; Spinal needle; Lumbar puncture
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2015.03.009

Abstract Background context The most common adverse event after a lumbar puncture (LP) is a headache: In anaesthesiology, well studied is the protective effect of atraumatic spinal needles, and they are routinely used. However, this is less well known in diagnostic LP, and neurologists use atraumatic needles in less than 2% of times. Purpose The purpose of this study was to define the impact of needle type, atraumatic (Sprotte [S]) versus traumatic (Quincke [Q]) on postdural puncture headache (PDPH) incidence. Study design The study is based on a prospective, randomized, and simple-blinded clinical trial. Patient Sample Patients older than 14 years were scheduled for a diagnostic or therapeutic LP. Outcome Measures The outcome measure included the development of PDPH according to the International Headache Association criteria. Methods Patients fulfilling eligibility criteria were randomly allocated to one of two kinds of spinal needle: atraumatic or S-type or traumatic or Q-type. They were interviewed on days 2 and 7 about the development of PDPH. Results The incidence of PDPH was 22.43% with Q-type needle and 8.51% with S-type needle, p=.04. The duration of PDPH in patients in the S-type was 1 day or less, compared with a median of 4.14 days in the Q-type (p=.00). In the logistic regression model, the S-type needle together with the age of the patient were the only two statistically significant factors in the development of postlumbar puncture headache (PLPH), both of them being protective. Conclusions We found a lower incidence of PDPH with atraumatic needles, and it was statistically significant compared with the traumatic needles. Our study confirms the effectiveness of the atraumatic needles to prevent PDPH.