Atraumatic Needles Drastically Reduce Post-LP Headache

Written by Clay Smith

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In this large meta-analysis of 110 RCTs, the incidence of post-dural puncture headache (PDPH) was only 4.2% with use of atraumatic spinal needles compared to conventional LP needles at 11%; NNT = 14.  This is a game-changer.

 From cited article. Atraumatic needle on left.

From cited article.
Atraumatic needle on left.

Why does this matter?
PDPH is a common complication of lumbar puncture, occurring in over 10% of patients.  It is notoriously difficult to treat in some patients, many of whom will require another invasive procedure (epidural blood patch) to get relief.  If there was a simple way to avoid this, it would be a big win for patients.  Looks like there is.  Many thanks to @CoreySlovis for telling me about this article.

Is any needle jammed into your back atraumatic?
This was a very large systematic review and meta-analysis of 110 high-quality randomized trials, with over 31,000 patients.  They found the incidence of post-dural puncture headache (PDPH) was dramatically less using the atraumatic needle as opposed to the conventional spinal needle: 11% vs 4.2%.  That's a number needed to treat of 14, meaning one less PDPH for every 14 lumbar punctures done.  Every secondary outcome they looked at was also better in the atraumatic needle group, including need for IV fluid, pain medication, blood patch, any headache, nerve root irritation, or hearing disturbance.  And this was not at the expense of first-attempt success, which was identical between atraumatic and conventional needles.  Also, bloody tap and backache were the same.  These were high quality, RCTs.  The evidence doesn't get much better than this, so use of atraumatic needles should be a practice change we make.  Personally, I have tried them and found two challenges.  First, you need to push harder to advance the needle.  Next, if you choose to use a smaller gauge atraumatic needle, with the increased pressure needed to advance, the needle can bend and skew off target.  Be careful!  You have to make sure you control the directionality of the needle near the skin.

Source
Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis.  Lancet. 2018 Mar 24;391(10126):1197-1204. doi: 10.1016/S0140-6736(17)32451-0. Epub 2017 Dec 7.

Peer reviewed by Thomas Davis

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