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Impact of spinal needle type on postdural puncture headache among women undergoing Cesarean section surgery under spinal anesthesia: A meta‐analysis
Author(s) -
Lee Sang IL,
Sandhu Shabaaz,
Djulbegovic Benjamin,
Mhaskar Rahul S
Publication year - 2018
Publication title -
journal of evidence‐based medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.885
H-Index - 22
ISSN - 1756-5391
DOI - 10.1111/jebm.12311
Subject(s) - medicine , spinal anesthesia , cochrane library , anesthesia , meta analysis , incidence (geometry) , adverse effect , randomized controlled trial , bevel , anesthesiology , surgery , optics , engineering , physics , structural engineering
Abstract Objective Spinal anesthesia is the most frequently performed anesthesia for cesarean section. The American Society of Anesthesiology recommends using pencil‐point spinal needles (SNs) over cutting‐bevel SNs to reduce postdural puncture headache (PDPH) in their practice guidelines for obstetric anesthesia. However, there is no meta‐analysis addressing the impact of the type of SNs on PDPH among women undergoing Cesarean section surgery. Methods We conducted a systematic review and meta‐analysis including randomized controlled trials comparing the incidence of PDPH of pencil‐point SNs with cutting‐bevel SNs in patients undergoing Cesarean section with spinal anesthesia. A comprehensive search of PubMed, Cochrane Library, EMBASE, and CINAHL without using any language and time restrictions were performed. Results A total of 4936 patients from 20 studies (31 comparisons) were included. Pencil‐point SN leads to reduced PDPH (risk ratio [RR] 0.33, 95% confidence intervals [CI] 0.25 to 0.45) and reduced requirement of epidural blood patch (RR = 0.21, 95% CI 0.09 to 0.51) compared to cutting‐bevel SN. The incidence of anesthesia failure, non‐PDPH, backache, and other adverse effects was not statistically significantly difference between the two SNs. Overall quality of evidence was moderate to low. Conclusions Using pencil‐point SN appears to be beneficial for preventing PDPH in patients undergoing Cesarean section without increasing any potential adverse effects. Further research addressing the specific gauge of pencil‐point SNs, which might further reduce the incidence of PDPH is highly desired.