A prospective double-blind clinical trial, comparing the sharp Quincke needle (22G) with an “atraumatic” needle (22G) in the induction of post-lumbar puncture headache

Braune, H.-J.; Huffmann, G

doi:10.1111/j.1600-0404.1992.tb08053.x

Cited by 46 publications

(37 citation statements)

References 29 publications

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“…We found the frequency of PDPH to be as high as 33%. In contrast to our results it has been stated that with use of a 22-G blunt needle instead of a 20-G needle, the incidence of headache might be reduced from 30% to as low as 5% [11,17,18].…”

Section: Discussioncontrasting

confidence: 99%

“…Both of these reports were dealing with spinal anaesthesia, and the patients of Kokki et al were children. There are also some other studies favouring blunt-tip nee- #Estimated from 1 to 10, mean (SD) *Solely because of PDPH The differences between the groups are not statistically significant dles [18]. The whole question has not had a confirmed answer, especially when diagnostic puncture is concerned [19].…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic lumbar puncture. Comparative study between 22–gauge pencil point and sharp bevel needle

et al. 2005

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Post–lumbar puncture headache is a frequent clinical problem. Needle design is expected to reduce post–puncture headache. In this study, we compared two different lumbar puncture needle designs in diagnostic lumbar puncture and analysed post–dural puncture headache (PDPH) and social and economical harm associated with the diagnostic lumbar puncture procedure. This prospective, controlled study consisted of 80 consecutive adult patients requiring elective diagnostic lumbar puncture due to various neurological symptoms. Lumbar puncture was completed either with Spinocan ® 22 G sharp bevel needle or Whitacre ® 22G pencil point needle. Patients were asked about previous headache symptoms and pain provoked by puncture. One week after the lumbar puncture all patients were interviewed by telephone and occurrence and type of headache, headache intensity, medication and frequency of impairment in activities of daily living were asked. Need for epidural blood patch was also recorded. Thirty–three of 78 (42%) patients experienced headache after diagnostic lumbar puncture and in 26 (33%) the headache could be classified as PDPH. There were no statistically significant differences between needle types in the frequency of common headache, PDPH, puncture pain intensity, need for epidural blood patch or sick leave. Also, there were no other complications except local back pain or headache. In this study, the needle design did not affect the frequency of PDPH. Also, PDPH was common, occurring in 33% cases and caused a considerable amount of disturbance in daily activities. Seeking help for this condition was insufficient and only part of these PDPH patients were treated with epidural blood patch.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic lumbar puncture. Comparative study between 22–gauge pencil point and sharp bevel needle

et al. 2005

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“…35 There is limited evidence in diagnostic LPs. In particular, the two studies that report benefit for a noncutting needle compared with a cutting needle 36,37 did not state that bevel direction was parallel to the dural fibers in patients in whom a cutting needle was used. The second of the two reports was mainly a myelography series.…”

Section: Needle Designmentioning

confidence: 99%

Assessment: Prevention of post–lumbar puncture headaches

Evans¹,

Armon²,

Frohman³

et al. 2000

Neurology

247

136

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Headache (HA) is a common sequel to lumbar puncture (LP), whether performed for diagnosis or anesthesia. [1][2][3][4][5][6] In their monograph summarizing the world literature through 1960, Tourtellotte et al.1 considered separately three principal patient populations: 1) patients undergoing diagnostic LPs (excluding myelography, pneumoencephalography, and cisternal puncture), excluding also patients whose condition might reduce the reliability to report HA; 2) patients undergoing nonobstetric spinal anesthesia; and 3) patients undergoing obstetric spinal anesthesia. They reported several observations.1. The average frequency of post-LP HAs (PLPHA) in patients after diagnostic LP (excluding myelography, pneumoencephalography, and cisternal puncture), excluding also patients whose condition might reduce the reliability to report HA, was 32%. For nonobstetric spinal anesthesia, the average frequency was 13%. For obstetric spinal anesthesia, the average frequency was 18%. 2. In reports in which patients received special measures to prevent PLPHA, the average frequencies were 6% for diagnostic LPs, 5.5% for nonobstetric spinal anesthesia, and 6.2% for obstetric spinal anesthesia. The actual frequencies in individual series ranged from 0 to 18%. 3. The frequency of PLPHA was 36% in their own series of 105 normal individuals, 30% in 317 patients with diagnostic LPs, and 2% definite and 2% probable in 100 patients undergoing spinal anesthesia (but 30 patients with HAs of other types were excluded from the latter count).In analyzing risk factors for PLPHA, they concluded that the evidence, including their own prospective series, was convincing to consider younger age and female gender as definite risk factors. They attributed the difference of PLPHAs in obstetric and nonobstetric patients undergoing spinal anesthesia at least in part to these factors. They further considered the data fairly convincing that the smaller the needle size, the lower the frequency of PLPHA, but were unable to show this in their prospective series. They commented that the great variability of HA frequency for the same needle size between authors may reduce the reliability of this observation. With regard to all other risk factors, they concluded that the evidence was inconclusive. With regard to all preventive or therapeutic measures, they commented that proponents of a particular treatment, in general, found it to be beneficial; however, some of the reports were uncontrolled and some results could not be replicated by others. Today, we would consider the latter findings a result of publication bias-if one first tried a new approach to reducing the incidence of PLPHA, one would be less likely to publish a failure than a success.They commented on the different frequency of PLPHA in patients undergoing diagnostic LP compared with those undergoing spinal anesthesia, and considered the following factors in their series: age, gender, needle size, fasting, hydration, premedication and postoperative medication, minimal amount of trauma to the meninge...

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“…This effect is attributed to the atraumatic puncture of the spinal dura mater. 6 The use of Sprotte needles in diagnostic LP has not been reported. Post-puncture headache has been minimized by using needles with small diameters.'…”

Section: Discussionmentioning

confidence: 99%

Lower Values for Immunoglobulin M in Cerebrospinal Fluid When Sampled with an Atraumatic Sprotte Needle Compared with Conventional Lumbar Puncture

et al. 1995

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SUMMARY. Immunoglobulin M (lgM) has a very low concentration in cerebrospinal fluid (CSF) compared with serum, and therefore determinations of IgM in CSF are highly sensitive to pre-analytical errors caused by contamination with serum or interstitial fluid. Capillary attraction causes a thin layer of liquid containing serum proteins to be formed inside a conventional (Quincke) needle during penetration of tissue. To investigate this source of pre-analytical error, 35 patients had lumbar punctures using a 22 G atraumatic (Sprotte) or 25 G conventional (Quincke) needle according to a randomized scheme, and the IgM concentrations in CSF and serum were determined.The CSF IgM concentrations for samples taken with a Sprotte needle were significantly lower than those taken with a Quincke needle (P< O·05), whereas the corresponding serum IgM concentrations and CSF erythrocyte counts did not differ significantly. The difference indicates that CSF IgM concentrations determined after conventional sampling may be falsely increased by contamination. We conclude that IgM concentrations in CSF samples taken with the atraumatic technique are more accurate, and recommend the use of this technique when CSF IgM is to be determined. Additional key phrases: CNS infections; multiple sclerosis; pre-analytical errorsPre-analytical errors are often overlooked. In a recent study' we proposed that falsely increased levelsof immunoglobulin M (lgM) in cerebrospinal fluid (CSF) might be caused by contamination with small amounts of serum. Such contamination falsely increases the concentrations of all components which are present in serum at higher concentration than in CSF, and the relative error increases with decreasing CSF-serum ratio. Hence, trace contamination can significantly alter the CSF concentration of large molecular mass molecules, such as IgM, whereas the albumin and IgM concentrations are only negligiblyinfluenced.A pilot study revealed that coloured solutions could form a thin layer at the inside of a conventional (Quincke) spinal needle by capillary Correspondence: Dr S Ohman. 210attraction. This degree of contamination was sufficient to account for more than a 1001170 increase in the CSF IgM concentration.The pilot study led to the present study, where a conventional sampling technique/ was compared with sampling using Sprotte needles. These needles have an atraumatic, non-cutting edge minimizing damage to peripheral tissue before entering the lumbar sac. ' The aim of this study was to investigate whether sampling using atraumatic Sprotte needles could diminish the potential pre-analytical error caused by a liquid layer on the inside of the cannula. MATERIAL AND METHODSDiagnostic lumbar puncture (LP) was performed because of suspected infections of the central

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A prospective double-blind clinical trial, comparing the sharp Quincke needle (22G) with an “atraumatic” needle (22G) in the induction of post-lumbar puncture headache

Cited by 46 publications

References 29 publications

Diagnostic lumbar puncture. Comparative study between 22–gauge pencil point and sharp bevel needle

Diagnostic lumbar puncture. Comparative study between 22–gauge pencil point and sharp bevel needle

Assessment: Prevention of post–lumbar puncture headaches

Lower Values for Immunoglobulin M in Cerebrospinal Fluid When Sampled with an Atraumatic Sprotte Needle Compared with Conventional Lumbar Puncture

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