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

Castrillo, A. Hernandez; Tabernero, C; García-Olmos, Luis M.; Gil, Cecilia; Gutiérrez, Raúl; Zamora, M; Mendoza, A Del Barrio; Rodríguez, María Fernández; Guerrero, Pilar; Rodríguez-Vico, Jaime Samuel; Ferrero, Marta; Morollón, Noemí; Duarte, Jacinto

doi:10.1016/j.spinee.2015.03.009

Cited by 39 publications

(30 citation statements)

References 23 publications

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“…The incidence of PDPH in the Quincke group was approximately seven times more than Whitacre group. Also many researchers found a leak reduction of PDPH when using a Whitacre needle compared with cutting point needles [10][11][12][13][14]. In our study the frequency of PDPHA was similar to Quincke group in their study.…”

Section: Discussionsupporting

confidence: 84%

The Rate of Headache after Caesarean Section and the Size of Needle for Spinal Anesthesia: Clinical Trial

Khooshideh¹,

Shahriari²,

Bitarafan³

2017

Int J Neurorehabilitation Eng

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Section: Discussionsupporting

confidence: 84%

The Rate of Headache after Caesarean Section and the Size of Needle for Spinal Anesthesia: Clinical Trial

Khooshideh¹,

Shahriari²,

Bitarafan³

2017

Int J Neurorehabilitation Eng

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“…PDPH is more frequent in the female gender, [9,15] as women have almost twice the risk of developing a PDPH in comparison with men. [7,9,43–45] It is more common in reproductive age group and pregnant females.…”

Section: Resultsmentioning

confidence: 99%

“…[3,10,11] The smaller needle diameter had been thought effective to reduce the incidence of PDPH. [9,15] However, extremely thin spinal needles would increase the rate of failure for spinal anesthesia, resulting in multiple dural punctures and high incidence rate of PDPH. [10,16–19] Apart from the spinal needle size, spinal needle shape might be the most important modifiable risk factors of PDPH.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache

et al. 2017

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Background:Postdural puncture headache (PDPH), mainly resulting from the loss of cerebral spinal fluid (CSF), is a well-known iatrogenic complication of spinal anesthesia and diagnostic lumbar puncture. Spinal needles have been modified to minimize complications. Modifiable risk factors of PDPH mainly included needle size and needle shape. However, whether the incidence of PDPH is significantly different between cutting-point and pencil-point needles was controversial. Then we did a meta-analysis to assess the incidence of PDPH of cutting spinal needle and pencil-point spinal needle.Methods:We included all randomly designed trials, assessing the clinical outcomes in patients given elective spinal anesthesia or diagnostic lumbar puncture with either cutting or pencil-point spinal needle as eligible studies. All selected studies and the risk of bias of them were assessed by 2 investigators. Clinical outcomes including success rates, frequency of PDPH, reported severe PDPH, and the use of epidural blood patch (EBP) were recorded as primary results. Results were evaluated using risk ratio (RR) with 95% confidence interval (CI) for dichotomous variables. Rev Man software (version 5.3) was used to analyze all appropriate data.Results:Twenty-five randomized controlled trials (RCTs) were included in our study. The analysis result revealed that pencil-point spinal needle would result in lower rate of PDPH (RR 2.50; 95% CI [1.96, 3.19]; P < 0.00001) and severe PDPH (RR 3.27; 95% CI [2.15, 4.96]; P < 0.00001). Furthermore, EBP was less used in pencil-point spine needle group (RR 3.69; 95% CI [1.96, 6.95]; P < 0.0001).Conclusions:Current evidences suggest that pencil-point spinal needle was significantly superior compared with cutting spinal needle regarding the frequency of PDPH, PDPH severity, and the use of EBP. In view of this, we recommend the use of pencil-point spinal needle in spinal anesthesia and lumbar puncture.

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“…These factors may include age, female sex, needle size and type, pregnancy, previous history of PDPH, median-paramedian difference in approach, puncture level. [123456] The PDPH, which cause significant morbidity in obstetric patients, has higher incidence because of the increased cerebrospinal fluid (CSF) pressure related to pregnancy, dehydration, blood loss, postpartum diuresis, hormonal imbalance, high serum estrogen levels, and increased peridural pressure. [246]…”

Section: Introductionmentioning

confidence: 99%

The postdural puncture headache and back pain: The comparison of 26-gauge atraucan and 26-gauge quincke spinal needles in obstetric patients

et al. 2017

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Background:The postdural puncture headache (PDPH) and postdural puncture backache (PDPB) are well-known complications of spinal anesthesia. There are some attempts to reduce the frequency of complication such as different design of the spinal needles.Aims:The primary outcome of this study is to compare the incidence of PDPH between 26-gauge Atraucan and 26-gauge Quincke spinal needles in elective cesarean operations. The severity of symptoms, the incidence of backache, technical issues, and comparison of cost of needles are secondary outcomes.Materials and Methods:After Investigational Review Board approval, a randomized, prospective, double-blinded study was designed in 682 American Society of Anesthesiologists I–II women having elective cesarean operations under spinal anesthesia. Patients were divided into two groups as 26-gauge Atraucan Group A (n = 323) and 26-gauge Quincke spinal needles Group Q (n = 342). All patients were questioned about backache 1 week later. Differences between categorical variables were evaluated with Chi-square test. Continuous variables were compared by Student's t-test for two independent groups. A two-sided P < 0.05 was considered statistically significant for all analyses.Results:There were no significant differences between groups in all demographic data. The one attempt success rate of the dural puncture in Group A (70,58%) and in Group Q (69.3%) was similar (P > 0.05). The incidence of PDPH was 6.5% in Group A and 4.9% in Group Q (P > 0.05). The epidural blood patch was performed to the three patients in Group A and five patients in Group Q who had severe headache (P > 0.05). The incidence of PDPB was 4.33% versus 2.04% in Group A and Group Q (P > 0.05).Conclusions:The incidence of complication rates and technical handling characteristics did not differ between two groups. Quincke needle is cheaper than Atracaun needle, so it can be a cost-effective choice in obstetric patients.

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

Cited by 39 publications

References 23 publications

The Rate of Headache after Caesarean Section and the Size of Needle for Spinal Anesthesia: Clinical Trial

The Rate of Headache after Caesarean Section and the Size of Needle for Spinal Anesthesia: Clinical Trial

Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache

The postdural puncture headache and back pain: The comparison of 26-gauge atraucan and 26-gauge quincke spinal needles in obstetric patients

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