Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis

This study is registered with the International Prospective Register of Systematic Reviews, number CRD42016047546. Findings We identified 20 241 reports; after exclusions, 110 trials done between 1989 and 2017 from 29 countries, including a total of 31 412 participants, were eligible for analysis. The incidence of postdural-puncture headache was significantly reduced from 11·0% (95% CI 9·1–13·3) in the conventional needle group to 4·2% (3·3–5·2) in the atraumatic group (relative risk 0·40, 95% CI 0·34–0·47, p<0·0001; I 2=45·4%). Atraumatic needles were also associated with significant reductions in the need for intravenous fluid or controlled analgesia (0·44, 95% CI 0·29–0·64; p<0·0001), need for epidural blood patch (0·50, 0·33–0·75; p=0·001), any headache (0·50, 0·43–0·57; p<0·0001), mild headache (0·52, 0·38–0·70; p<0·0001), severe headache (0·41, 0·28–0·59; p<0·0001), nerve root irritation (0·71, 0·54–0·92; p=0·011), and hearing disturbance (0·25, 0·11–0·60; p=0·002). Success of lumbar puncture on first attempt, failure rate, mean number of attempts, and the incidence of traumatic tap and backache did not differ significantly between the two needle groups. Prespecified subgroup analyses of postdural-puncture headache revealed no interactions between needle type and patient age, sex, use of prophylactic intravenous fluid, needle gauge, patient position, indication for lumbar ...
Source: The Lancet - Category: General Medicine Source Type: research