Diagnostic lumbar puncture. Comparative study between 22–gauge pencil point and sharp bevel needle

摘要

Post–lumbar puncture headache is a frequent clinical problem. Needle design is expected to reduce post–puncture headache. In this study, we compared two different lumbar puncture needle designs in diagnostic lumbar puncture and analysed post–dural puncture headache (PDPH) and social and economical harm associated with the diagnostic lumbar puncture procedure. This prospective, controlled study consisted of 80 consecutive adult patients requiring elective diagnostic lumbar puncture due to various neurological symptoms. Lumbar puncture was completedeither with Spinocan^® 22 G sharpbevel needle or Whitacre^® 22Gpencil point needle. Patients wereasked about previous headachesymptoms and pain provoked bypuncture. One week after the lumbarpuncture all patients were interviewedby telephone and occurrenceand type of headache, headacheintensity, medication and frequencyof impairment in activities of dailyliving were asked. Need for epiduralblood patch was also recorded.Thirty–three of 78 (42%) patientsexperienced headache after diagnosticlumbar puncture and in 26 (33%)the headache could be classified asPDPH. There were no statisticallysignificant differences between needletypes in the frequency of commonheadache, PDPH, puncturepain intensity, need for epiduralblood patch or sick leave. Also,there were no other complicationsexcept local back pain or headache.In this study, the needle design didnot affect the frequency of PDPH.Also, PDPH was common, occurringin 33% cases and caused a considerableamount of disturbance indaily activities. Seeking help forthis condition was insufficient andonly part of these PDPH patientswere treated with epidural bloodpatch.