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Evidence summaries

Needle Gauge and Tip Designs for Preventing Post-Dural Puncture Headache

Atraumatic needles appear to reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache. Level of evidence: "B"

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment).

Summary

A Cochrane review [Abstract] 1 included 66 studies with a total of 17,067 subjects. As for the indications for lumbar puncture, 57 studies undertook it to administer anaesthesia. The main outcome was prevention of post-dural puncture headache (PDPH), but also the onset of severe PDPH, headache in general and adverse events were assessed. There were 3 main comparisons

  1. Traumatic needles vs. atraumatic needles: The use of traumatic needles showed a higher risk of onset of PDPH compared to atraumatic needles (RR 2.14, 95% CI 1.72 to 2.67; 36 studies, n=9378).
  2. Larger gauge traumatic needles vs. smaller gauge traumatic needles: Studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH, with the exception of one study comparing 26 and 27 gauge needles (RR 6.47, 95% CI 2.55 to 16.43; one study, n=658).
  3. Larger gauge atraumatic needles vs. smaller gauge atraumatic needles: Studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH.

There was no significant difference in the risk of paraesthesia, backache, severe PDPH and any headache between traumatic and atraumatic needles.

Clinical comments

Note

Date of latest search:

References

  • Arevalo-Rodriguez I, Muñoz L, Godoy-Casasbuenas N et al. Needle gauge and tip designs for preventing post-dural puncture headache (PDPH). Cochrane Database Syst Rev 2017;4():CD010807. [PubMed]

Primary/Secondary Keywords