The Impact of Spinal Needle Selection on Postdural Puncture Headache

Zorrilla-Vaca, Andrés; Mathur, Vineesh; Wu, Christopher L.; Grant, Michael C.

doi:10.1097/aap.0000000000000775

Cited by 25 publications

(10 citation statements)

References 42 publications

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“…CSF aspiration did not therefore appear to have influenced the attained block height. Complication rates were lower or comparable with those of previous studies (44)(45)(46). Our results show that banking of CSF from a surgical population is feasible and does not appear to pose any significant additional risks to participating patients.…”

Section: Discussionsupporting

confidence: 86%

The Anaesthetic Biobank of Cerebrospinal fluid: a unique repository for neuroscientific biomarker research

Tigchelaar¹,

Atmosoerodjo²,

Faassen³

et al. 2021

Ann Transl Med

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Background:The pathophysiology of numerous central nervous system disorders remains poorly understood. Biomarker research using cerebrospinal fluid (CSF) is a promising way to illuminate the neurobiology of neuropsychiatric disorders. CSF biomarker studies performed so far generally included patients with neurodegenerative diseases without an adequate control group. The Anaesthetic Biobank of Cerebrospinal fluid (ABC) was established to address this. The aims are to (I) provide healthy-control reference values for CSF-based biomarkers, and (II) to investigate associations between CSF-based candidate biomarkers and neuropsychiatric symptoms.Methods: In this cross-sectional study, we collect and store CSF and blood from adult patients undergoing spinal anaesthesia for elective surgery. Blood (20.5 mL) is collected during intravenous cannulation and CSF (10 mL) is aspirated prior to intrathecal local anaesthetic injection. A portion of the blood and CSF is sent for routine laboratory analyses, the remaining material is stored at −80 ℃. Relevant clinical, surgical and anaesthetic data are registered. A neurological examination and Montreal Cognitive Assessment (MoCA) are performed pre-operatively and a subset of patients fill in questionnaires on somatic and mental health (depression, anxiety and stress).Results: Four-hundred-fifty patients (58% male; median age: 56 years) have been enrolled in the ABC.The planned spinal anaesthetic procedure was not attempted for various reasons in eleven patients, in fourteen patients the spinal puncture failed and in twelve patients CSF aspiration was unsuccessful. A mean of 9.3 mL CSF was obtained in the remaining 413 of patients. Most patients had a minor medical history and 60% scored in the normal range on the MoCA (median score: 26). Conclusions:The ABC is an ongoing biobanking project that can contribute to CSF-based biomarker research. The large sample size with constant sampling methods and extensive patient phenotyping provide excellent conditions for future neuroscientific research.

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Section: Discussionsupporting

confidence: 86%

The Anaesthetic Biobank of Cerebrospinal fluid: a unique repository for neuroscientific biomarker research

Tigchelaar¹,

Atmosoerodjo²,

Faassen³

et al. 2021

Ann Transl Med

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“…The lack of difference between the two gauges of Sprotte needles is in line with a recent meta-analysis concluding that needle gauge in pencil-point needles does not correlate as much with PDPH as in cutting needles [3]. The fact that no case of PDPH was evidenced with the 27G Sprotte needle in the group of patients with previous PDPH or migraine confirms that this approach is an effective prophylactic measure for the occurrence of PDPH in this high risk population.…”

Section: Discussionsupporting

confidence: 79%

“…Current evidence suggests that pencil-point spinal needles are significantly superior compared to cutting spinal needles regarding the frequency of PDPH [1,2]. Moreover, the impact of needle gauge on PDPH has been shown to be less important in pencil-point as compared to cutting needles [3]. Atraucan is a double-beveled needle containing cutting and blunt components of the bevel.…”

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confidence: 99%

Impact of spinal needle design and approach to postdural puncture headache and spinal anesthesia failure in obstetrics

Batova¹,

Georgiev²

2019

ait

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Obstetric patients have a higher incidence of postdural puncture headache (PDPH) than the corresponding incidence in the general population. Current evidence suggests that pencil-point spinal needles are significantly superior compared to cutting spinal needles regarding the frequency of PDPH [1,2]. Moreover, the impact of needle gauge on PDPH has been shown to be less important in pencil-point as compared to cutting needles [3]. Atraucan is a double-beveled needle containing cutting and blunt components of the bevel. It was categorized as a non-traumatic needle in a recent meta-analysis [1] but its place regarding PDPH is not fully elucidated. Introducing cutting needles with the bevel parallel to the longitudinal dural fibers is found to be a factor associated with reduction of the incidence of PDPH [4].The notion that the paramedian approach decreases the incidence of PDPH is supported by studies in models of the dura mater in vitro showing that the oblique angle of dural puncture causes less leakage across the dura [5,6]. Clinical studies regarding the influence of the paramedian approach on PDPH have shown contradictory results.The association between the patient's position during lumbar puncture and PDPH was the object of Abstract Background: Concern has been raised that Sprotte needles predispose to spinal anes thesia failure. Nevertheless, these needles are associated with a low incidence of post dural puncture headache. The impact of the paramedian approach to postdural punc ture headache remains controversial. The objective of this prospective randomized study was to compare Sprotte, Quincke and Atraucan needles as well as the midline and the paramedian approach in terms of postdural puncture headache and spinal anesthesia failure in patients undergoing Caesarean section.Methods: 655 patients were randomized to 5 groups. A midline approach was used in four groups. The spinal needles were the 25G Sprotte, 27G Sprotte, 26G Atraucan and 25G Quincke. In the fifth group a 25G Quincke needle was used by the paramedian approach.Results: The incidence of postdural puncture headache was 0% in both 25G and 27G Sprotte groups, 2.5% in the 26G Atraucan group, and 7.2% and 2.7% in the 25G Quincke midline and paramedian approach respectively. A significant difference in terms of post dural puncture headache was found between 25G Sprotte and 25G Quincke needles (P = 0.004), while the failure rate was similar between these two needles. A significant difference in spinal anesthesia failure rate was observed between midline and parame dian approaches (P = 0.041).Conclusions: Sprotte but not Atraucan needle design correlates with lower incidence of postdural puncture headache compared to Quincke design. Sprotte needles are not associated with a higher spinal anesthesia failure compared to Quincke needles. The incidence of postdural puncture headache by the paramedian approach is not sig nificantly reduced whereas the spinal anesthesia failure rate is increased in comparison to the midline approach.

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“…Postpartum headache is quite common: it has been estimated that up to 39–40% of women experience headaches in the postpartum weeks [ 2 , 3 ]. Tension (39%), pre-eclampsia/eclampsia (24%), migraines (11%), hemorrhage, thrombosis, or vasculopathy (10%), and post-dural puncture headache (PDPH) (16%) are the reported possible causes of headaches in the postpartum [ 2 , 4 , 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Don’t Forget Rare Causes of Postpartum Headache! Cases Report and Literature Review

et al. 2021

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Headache is a common finding in the postpartum period, caused by a spectrum of different conditions. Most headaches in the postpartum period are self-limiting and benign in etiology, but there are some potentially serious causes to be considered. We disclose two cases of postpartum headache, initially considered as post-dural puncture headache (PDPH), that evolved into a harmful condition and showed that an expanded differential diagnosis for headache in the postpartum is mandatory, requiring a high level of attention from health professionals. In fact, a careful examination of the medical history, physical examination, and the recognition for the need for early neuroradiological imaging should incre[se diagnostic accuracy.

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The Impact of Spinal Needle Selection on Postdural Puncture Headache

Cited by 25 publications

References 42 publications

The Anaesthetic Biobank of Cerebrospinal fluid: a unique repository for neuroscientific biomarker research

The Anaesthetic Biobank of Cerebrospinal fluid: a unique repository for neuroscientific biomarker research

Impact of spinal needle design and approach to postdural puncture headache and spinal anesthesia failure in obstetrics

Don’t Forget Rare Causes of Postpartum Headache! Cases Report and Literature Review

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