The association between post‐dural puncture headache and needle type during spinal anaesthesia: a systematic review and network meta‐analysis

Abstract

Summary Post‐dural puncture headache is one of the most undesirable complications of spinal anaesthesia. Previous pairwise meta‐analyses have either compared groups of needles or ranked individual needles based on the pooled incidence of post‐dural puncture headache. These analyses have suggested both the gauge and needle tip design as risk‐factors, but failed to provide an unbiased comparison of individual needles. This network meta‐analysis compared the odds of post‐dural 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‐analysis was the incidence of post‐dural puncture headache. Secondary outcomes were procedural failure, backache and non‐specific headache. Overall, we compared 11 different needles in 61 randomised controlled trials including a total of 14,961 participants. The probability of post‐dural puncture headache and procedural failure was lowest with 26‐G atraumatic needles. The 29‐G cutting needle was more likely than three atraumatic needles to have the lowest odds of post‐dural puncture headache, although with increased risk of procedural failure. The probability rankings were: 26 atraumatic > 27 atraumatic > 29 cutting > 24 atraumatic > 22 atraumatic > 25 atraumatic > 23 cutting > 22 cutting > 25 cutting > 27 cutting = 26 cutting for post‐dural puncture headache; and 26 atraumatic > 25 cutting > 22 cutting > 24 atraumatic > 22 atraumatic > 25 atraumatic > 26 cutting > 29 cutting > 27 atraumatic = 27 cutting for procedural success. Meta‐regression by type of surgical population (obstetric/non‐obstetric) 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‐G atraumatic needle is most likely to enable successful insertion while avoiding post‐dural puncture headache but, where this is not available, our probability rankings can help clinicians select the best of available options.

Downregulation of CSF-derived miRNAs miR-142-3p and miR-17-5p may be associated with post-dural puncture headache in pregnant women upon spinal anesthesia

“… 39 Studies which investigate the incidence of PDPH in pregnant women have sample size ranging from 100 to 250,000. 40 , 41 PDPH incidence in our study is higher than the ones reported in the literature for atraumatic needles in obstetrics patients. However, number of subjects in our study is low (n = 24) to infer a PDPH incidence.…”

Do Spinal Needle Sizes Affect the Development of Traumatic CSF in Neonatal LP Procedures?

“…In addition, this study compared 22 pen G and 25 pen G spinal needles, and the efficacy of small spinal needles was not investigated. Maranhao et al [ 58 ] compared the effect of needle groups on PDPH, a particularly undesirable complication of spinal anesthesia, in adults. The lowest likelihood of post-dural puncture headache and unsuccessful procedures in that study was achieved with 26 G atraumatic needles [ 58 ].…”

Troubleshooting obstetric spinal anaesthesia at district hospital level

“…There is ample evidence that an atraumatic needle, such as the pencil-point needle, reduces the incidence of PDPH following obstetric spinal anaesthesia (risk ratio: 0.33, 95% confidence interval: 0.25–0.45), 12 whilst the conventional ‘cutting’ needle (Quincke needle) has a high incidence of PDPH when compared with similar gauges. 13 There is no difference in success rates between the two needles once practitioners become familiar with both techniques. It is possible that the Quincke needle is favoured for medical lumbar punctures in district hospitals and thus used when pencil-point needles are unavailable because of supply chain issues.…”