SOURCE
Arevalo-Rodriguez I, Muñoz L, Godoy-Casasbuenas N, et al. (2017). Needle gauge and tip designs for preventing post-dural puncture headache (PDPH). Cochrane Database Syst Rev 4:CD008874

CONTEXT
Post-dural puncture headache (PDPH) is defined as a postural headache occurring within 3 days of a lumbar puncture (LP). It happens less than 15 minutes after sitting or standing and resolves within 15 minutes of assuming a supine position. PDPH is common occurring in up to 36% of diagnostic LPs. Different types (atraumatic/traumatic) and diameters of needles are used to perform LPs.

CLINICAL QUESTION
Does the use of atraumatic needles and/or small diameter needles reduce the incidence of PDPH and adverse events such as paresthesia, headache and lower back pain following diagnostic lumbar puncture?

BOTTOM LINE
Atraumatic needles reduce the incidence of PDPH by half (moderate level of evidence). There is no statistical difference in the incidence of severe PDPH (low level of evidence) or the risk of paresthesia or lumbar pain (moderate level of evidence). Furthermore, atraumatic needles reduced the risk of “any headache”(moderate level of evidence).
The diameter of traumatic or atraumatic needles does not influence the risk of PDPH nor the risk of low back pain or headache (moderate level of evidence).

CAVEAT
Although the majority of the evidence in this meta-analysis is derived from anaesthesia trials (90% of subjects), analysis of studies on diagnostic LPshow a similar reduction in the risk of PDPH with the use of atraumatic needles. Technical difficulties (number of LP attempts) related to either needle type or gauge could not be evaluated by the authors.

AUTHORS INFORMATION

Yannick AUFFRET
Centre Hospitalier Régional Universitaire de Brest
Brest, France
y.auffret@ch-cornouaille.fr

Sébastien BEROUD
Hospices civils de Lyon, CHU Lyon-Sud,
Lyon, France
sebastien.beroud@chu-lyon.fr

Kirk MAGEE
Dalhousie University –QEII Health Science Centre
Nova Scotia, Canada
kirk.magee@dal.ca