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Atraumatic needle reduces the incidence of post-lumbar puncture syndrome

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Abstract

We investigated the occurrence of the post-lumbar syndrome (PPS) in relation to the puncture technique used, in a prospective randomised double-blind study comprising 100 patients. A new atraumatic 22-gauge cannula was compared with a 20-gauge cannula with a Quincke bevel. The atraumatic cannula is a needle with a tip shaped like a closed circular cone with a lateral opening, usually used with an outer cannula (introducer). The study showed that both the frequency of PPS and of acute complaints during lumbar puncture can be dramatically reduced with the atraumatic puncture technique. A marked PPS occurred after lumbar puncture with the 20-gauge cannula in 31% of patients, whereas only 5% of patients reported marked post-puncture symptoms after lumbar puncture with the atraumatic cannula.

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References

  1. Adler H (1943) A study of the headaches following diagnostic spinal taps. N Y State J Med 43:1328–1330

    Google Scholar 

  2. Aguilera Celorrio L, Martínez-Garbizu I, Sáez de Equilaz Izaola JL, Arizaga Maguregui A, Sarrionaindí Azola S, Arteta Barcena M, Ortega Lago LF, Martínez Bourio Múgica R, Gutiérrez des Valle yJC (1989): Influencia del bisel de la aguja, edad y sexo en la aparición de cefalea pospunción dural. Rev Esp Anestesiol Reanim 36:16–19

    PubMed  Google Scholar 

  3. Daniels AM, Sallie R (1981): Headache, lumbar puncture and expectation. Lancet 1: 1003

    Article  Google Scholar 

  4. De Boer WA (1987) (in Dutch). Ned Tijdschr Geneesk 131:2009–2012

  5. Diener HC, Bendig M, Hempel V (1985) Der postpunktionelle Kopfschmerz. Fortschr Neurol Psychiatr 53: 344–349

    PubMed  Google Scholar 

  6. Dieterich M, Brandt T (1985) Is obligatory bed rest after lumbar puncture obsolete? Eur Arch Psychiatry Neurol Sci 235:71–75

    Article  PubMed  Google Scholar 

  7. Dietrich M, Brandt T (1988) Incidence of post-lumbar puncture headache is independent of daily fluid intake. Eur Arch Psychiatry Neurol Sci 237: 194–196

    Article  PubMed  Google Scholar 

  8. DiGiovanni AJ, Dunbar BS (1970) Epidural injections of autologous blood for postlumbar-puncture headache. Anesth Analg 49:268–271

    PubMed  Google Scholar 

  9. Easton JD (1979) Headache after lumbar puncture. Lancet I: 974–975

    Article  Google Scholar 

  10. Eicke H (1930) Die ambulante Lumbalpunktion mittels Kapillarnadel. Med Welt 12:399–401

    Google Scholar 

  11. Engelmeier M-P (1953) Über atypische Beschwerden nach der Lumbalpunktion. Med Welt 49:1579–1581

    Google Scholar 

  12. Gass H, Goldstein AS, Ruskin R, Leopold NA (1971) Chronic postmyelogram headache. Isotopic demonstration of dural leak and surgical cure. Arch Neurol 25:168–170

    PubMed  Google Scholar 

  13. Gerner RH (1979) A technique to prevent headaches after diagnostic lumbar puncture. West J Med 131:160–161

    PubMed  Google Scholar 

  14. Hart JR, Whitacre RJ (1951) Pencilpoint needle in prevention of postspinal headache. JAMA 147:657–658

    Google Scholar 

  15. Hilton-Jones D (1984) What is postlumbar puncture headache and is it avoidable? In: Warlow C, Garfield J (eds) Dilemmas in the management of the neurological patient. Churchil Livingston, Edinburgh, pp 144–157

    Google Scholar 

  16. Kadrie H, Driedger AA, McInnis W (1976) Persistent dural cerebrospinal fluid leak shown by retrograde radionuclide myelograhie: case report. J Nucl Med 17:797–799

    PubMed  Google Scholar 

  17. Kovanen J, Sulkava R (1986) Duration of postural headache after lumbar puncture: effect of needle size. Headache 26:224–226

    Article  PubMed  Google Scholar 

  18. Kuhlendahl H (1950) Über den Auslbsungsmechanismus zentralnervöser vegetativer Reaktionen, insbesondere bei Encephalographie. Klin Wochenschr 28:544–548

    Article  PubMed  Google Scholar 

  19. Kunkle EC, Ray BS, Wolff HG (1943) Experimental studies on headache. Analysis of the headache associated with changes in intracranial pressure. Arch Neurol Psychiatry 49:323–358

    Google Scholar 

  20. Loeser EA, Hill GE, Bennett GM, Sederberg JH (1978) Time vs. success rate for epidural blood patch. Anesth 49:147–148

    Google Scholar 

  21. Low PA, Pfeifer MA (1993) Standardization of clinical tests for practise on clincal trials. In: Low PA (ed) Clinical autonomic disorders. Little, Brown, Boston, pp 287–312

    Google Scholar 

  22. McGruder JM, Cooke JE, Conroy JM, Baker JD (1988) Headache after lumbar puncture: review of the epidural blood patch. South Med J 81: 1249–1252

    PubMed  Google Scholar 

  23. Rando TR, Fishman RA (1992) Spontaneous intracranial hypotension: report of two cases and review of the literature. Neurology 42:481–487

    PubMed  Google Scholar 

  24. Raymond JR, Raymond PA (1988) Post-lumbar puncture headache. Etiology and management. West J Med 148:551–554

    PubMed  Google Scholar 

  25. Schaltenbrand G (1938) Neuere Anschauungen zur Pathophysiologie der Liquorzirkulation. Zentralbi Neurochir 3:290–300

    Google Scholar 

  26. Schaltenbrand G (1940) Die akute Aliquorrhoe. Verh Dtsch Ges Inn Med 52:473–481

    Google Scholar 

  27. Schorr MR (1966) Needles — some points to think about. Anesth Analg 45:509–526

    PubMed  Google Scholar 

  28. Sicuteri F (1966) Headache and meningismus evoked by lumbar puncture and subarachnoid hemorrhage: a biochemical interpretation. Headache 5:108–110

    Article  PubMed  Google Scholar 

  29. Sprotte G, Schedel R, Pajunk H (1987) Eine “atraumatische” Universalkanüle für einzeitige Regionalanästhesien. Reg Anesth 10:104–108

    Google Scholar 

  30. Torrey EF (1979) Headaches after lumbar puncture and insensitivity to pain in psychiatric patients. N Engl J Med 301:110

    Google Scholar 

  31. Tourtelotte WW, Haerer AF, Heller GL (1964) Post-lumbar puncture headache. Thomas, Springfield, pp 3–47

    Google Scholar 

  32. Tourtelotte WW, Henderson WG, Tucker RP, Gilland O, Walker JE, Kokman E (1972) A randomized, double-blind clincial trial comparing the 22 versus the 26 gauge needle in the production of the post-lumbar puncture syndrome in normal individuals. Headache 12:73–78

    Article  PubMed  Google Scholar 

  33. Trautmann E (1928) Über Ursachen, Wesen und Verhütung des sogenannten Meningismus nach Lumbalpunktion. Klin Wochenschr 7:695–699

    Article  Google Scholar 

  34. Van den Hout JHW, Feldberg MAM (1988) (in Dutch). Ned Tijdschr Geneeskd 132:177

  35. Vilming ST, Schrader H, Monstad I (1988) Post-lumbar-puncture headache: the significance of body posture. A controlled study of 300 patients. Cephalgia 8:75–78

    Article  Google Scholar 

  36. Wiggli U, Oberson R (1975) Die Häufigkeitextra-arachnoidalen Liquorausflußes nach Lumbalpunktion. Schweiz Med Wochenschr 105:235–239

    PubMed  Google Scholar 

  37. Zerssen D von (1971) Zur standardisierten isierten psychopathologischen Befunderhebung im Rahmen epidemiologischer Untersuchungen. Zentralbl Gesamte Neurol Psychiat 203:246

    Google Scholar 

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Müller, B., Adelt, K., Reichmann, H. et al. Atraumatic needle reduces the incidence of post-lumbar puncture syndrome. J Neurol 241, 376–380 (1994). https://doi.org/10.1007/BF02033354

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  • DOI: https://doi.org/10.1007/BF02033354

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