Open AccessOccurrence of postdural puncture headache—A randomized controlled trial comparing 22G Sprotte and Quincke
Author(s) -
Sjulstad Ane Skaare,
Odeh Francis,
Baloch Farid K.,
Berg Diana Hristova,
Arntzen Kathrine,
Alstadhaug Karl B.
Publication year - 2020
Publication title -
brain and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.915
H-Index - 41
ISSN - 2162-3279
DOI - 10.1002/brb3.1886
Subject(s) - medicine , lumbar puncture , randomized controlled trial , incidence (geometry) , lumbar , surgery , anesthesia , pediatrics , cerebrospinal fluid , physics , optics
Objective To assess the incidence of postdural puncture headache (PDPH) using 22‐gauge atraumatic needle ( Sprotte , 22GS) compared with 22‐gauge traumatic needle ( Quincke , 22GQ). Background Diagnostic lumbar puncture (dLP) is commonly complicated by PDPH. Despite evidence to support the use of 22GS, European neurologists seem to keep using 22GQ. Methods This was a randomized, double‐blind study. Adults (age: 18–60 years) scheduled for dLP were included. dLP and CSF acquisition were performed in accordance with highly standardized procedures. Patients were followed up on days 2 and 7. Results In total, 172 patients were randomized and lumbar punctured, and 21 were excluded due to wrong inclusion ( n = 11), needle switch ( n = 7), failed dLP ( n = 1), withdrawal ( n = 1), and missed follow‐up ( n = 1). Among the remaining 151 patients (mean age: 40.7 ± 12.4 years), 77 had dLP using 22GQ and 74 using 22GS. Incidence of PDPH among patients punctured with 22GS (18%) was significantly lower ( p = .004) than among patients punctured with 22GQ (39%). Relative risk was 0.45, 95% CI 0.26–0.80. Patients with PDPH had significantly lower weight ( p = .035), and there was no significant difference related to age ( p = .064), sex ( p = .239), height ( p = .857), premorbid episodic migraine ( p = .829), opening pressure ( p = .117), operators ( p = .148), amount of CSF removed ( p = .205), or number of attempts ( p = .623). Conclusions The use of 22GS halves the risk of PDPH compared with 22GQ. This study provides strong support to make a change in practice where traumatic needles are still in regular use.