Spinal Needle Determinants of Rate of Transdural Fluid Leak

Ready, L. B.; Cuplin, S.; Haschke, Richard H.; Nessly, Michael L.

doi:10.1213/00000539-198910000-00006

Cited by 114 publications

(21 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…29 Ready LB et al reported greater CSF leakage in the group where the dura fibres were entered transversely compared to the parallel entry group. 30 In the ongoing discussions, the findings of the current study support that the entry direction of the needle during lumbar dural punction and patient position could have significant effects on the incidence of PDPH.…”

Section: Discussionsupporting

confidence: 62%

<p>Is There An Effect On The Development Of Postdural Puncture Headache Of Dural Punction Made With The Spinal Needle In Three Different Orientations During Spinal Anaesthesia Applied To Pregnant Patients?</p>

Bıçak¹,

Salık²,

Akelma³

2019

JPR

View full text Add to dashboard Cite

Background and objectives: Postdural punction headache (PDPH) is a well-known and common complication of spinal anesthesia. The relationship between spinal needle size, configuration and perforation characteristics of the spinal needle and non-essential leak continues to be controversial. Methods: This prospective-randomized study included 300 patients aged 18-45 years who underwent cesarean section under spinal anesthesia. Spinal anesthesia was performed using a 26G Quincke spinal needle in the L3-4, or L4-5 range in the sitting position. Spinal anesthesia was performed with spinal needle sharp tip opening in the Group 1 patients, right or left laterally in Group 2 and caudal in Group 3, transducing the dural fibers transversely to the subarachnoid area, and directing the free opening of the needle to the spine. The patients were visited in the clinic where they were hospitalized at the 24th and 48th hours postoperatively, and phoned on the 3rd and 5th days after discharge, being questioned for PDPH. Results: It was observed that 64% of patients with PDPH developed within the first 24 hrs, 24% between 24 and 48 hrs and 48-72 hrs in 12%. The incidence of PDPH was 14% in Group 1, 8% in Group 2 and 3% in Group 3. This difference between the groups was statistically significant (p: 0.019). The incidence of PDPH was lower in Group 3 than in Group 1 and Group 2. Conclusion: We suggest that when spinal anesthesia is applied in the obstetric patient group if needle opening faces caudal this method will reduce the frequency of PDPH.

show abstract

Section: Discussionsupporting

confidence: 62%

<p>Is There An Effect On The Development Of Postdural Puncture Headache Of Dural Punction Made With The Spinal Needle In Three Different Orientations During Spinal Anaesthesia Applied To Pregnant Patients?</p>

Bıçak¹,

Salık²,

Akelma³

2019

JPR

View full text Add to dashboard Cite

show abstract

“…The LP feasibility study performed in memory clinic settings did not show that large‐bore diameter needles confer independent risk compared with small bore needle types. However, smaller bore needles (defined as ≥24G) are recommended by most studies [5,36,38,54–71], based on lower incidence of PLPH, back pain, and discomfort. A lower incidence of complications resulted in less medical assistance and less medication after the procedure.…”

Section: Resultsmentioning

confidence: 99%

“…However, atraumatic needles are recommended by most of the 37 articles as the best needle to perform LPs. Indeed, when comparing different needle designs, atraumatic needles resulted in a lower prevalence of post‐LP complaints, including PLPH, low back pain or nausea/vomiting (Table 4) [5,36,48,49,53,54,57,58,60,61,63–67,71,75,79–91]. A lower frequency of complications results in reduced health care costs due to less medication or medical assistance, such as blood patches [48,49,53,54,57,61,64,66,75,79–84,86–91,93,96].…”

Section: Resultsmentioning

confidence: 99%

Consensus guidelines for lumbar puncture in patients with neurological diseases

Engelborghs

Niemantsverdriet

Struyfs

et al. 2017

Alz & Dem Diag Ass & Dis Mo

262

280

View full text Add to dashboard Cite

IntroductionCerebrospinal fluid collection by lumbar puncture (LP) is performed in the diagnostic workup of several neurological brain diseases. Reluctance to perform the procedure is among others due to a lack of standards and guidelines to minimize the risk of complications, such as post-LP headache or back pain.MethodsWe provide consensus guidelines for the LP procedure to minimize the risk of complications. The recommendations are based on (1) data from a large multicenter LP feasibility study (evidence level II-2), (2) systematic literature review on LP needle characteristics and post-LP complications (evidence level II-2), (3) discussion of best practice within the Joint Programme Neurodegenerative Disease Research Biomarkers for Alzheimer's disease and Parkinson's Disease and Biomarkers for Multiple Sclerosis consortia (evidence level III).ResultsOur consensus guidelines address contraindications, as well as patient-related and procedure-related risk factors that can influence the development of post-LP complications.DiscussionWhen an LP is performed correctly, the procedure is well tolerated and accepted with a low complication rate.

show abstract

“…A longitudinal bevel orientation is more favorable in reducing the risk of PDPH when compared with a perpendicular orientation as showed in several laboratory [32] [33] and clinical [34] [35] studies.…”

Section: Needle Orientationmentioning

confidence: 99%

Post Dural Puncture Headache—Review and Suggested New Treatment

Kracoff¹,

Kotlovker²

2016

OJAnes

View full text Add to dashboard Cite

Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. Background: Post-dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia. The syndrome incidence was reported to be approximately 1% with typical obstetric anesthesiology practice which reflects more than 20,000 cases per 2014 in the US. Two possible mechanisms are hypothesized as responsible for this syndrome; cerebrospinal fluid leakage and pneumocephalus. Multiple methods of treatment have been applied with wide-ranging results. Design or Methods: Review article with introduction of a novel treatment option. Results: We postulate that Hyperbaric Oxygen Therapy can be used to treat postdural puncture headache. The rationale for treatment is dual: enhancement of fibroblast proliferation at the site of dural puncture to facilitate faster closure of the tear and compression of air bubbles in case of pneumocephalus according to Boyle's law. We also claim that hyperbaric oxygen therapy should be considered a prophylactic treatment, if a dural tear is suspected.

show abstract

Spinal Needle Determinants of Rate of Transdural Fluid Leak

Cited by 114 publications

References 0 publications

<p>Is There An Effect On The Development Of Postdural Puncture Headache Of Dural Punction Made With The Spinal Needle In Three Different Orientations During Spinal Anaesthesia Applied To Pregnant Patients?</p>

<p>Is There An Effect On The Development Of Postdural Puncture Headache Of Dural Punction Made With The Spinal Needle In Three Different Orientations During Spinal Anaesthesia Applied To Pregnant Patients?</p>

Consensus guidelines for lumbar puncture in patients with neurological diseases

Post Dural Puncture Headache—Review and Suggested New Treatment

Contact Info

Product

Resources

About