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Atraumatic Versus Conventional Lumbar Puncture Needles

A Systematic Review and Meta-Analysis

Nath, S.; Koziarz, A.; Badhiwala, J.H.; Alhazzani, W.; Jaeschke, R.; Sharma, S.; Banfield, L.; Shoamanesh, A.; Singh, S.; Nassiri, F.; Oczkowski, W.; Belley-Côté, E.; Truant, R.; Reddy, K.; Meade, M.O.; Farrokhyar, F.; Bala, M.M.; Alshamsi, F.; Krag, M.; Etxeandia-Ikobaltzeta, I.; Kunz, R.; Nishida, O.; Matouk, C.; Selim, M.; Rhodes, A.; Hawryluk, G.; Almenawer, S.A.

Obstetric Anesthesia Digest: December 2018 - Volume 38 - Issue 4 - p 205
doi: 10.1097/01.aoa.0000547304.03058.d8
Mechanisms, Equipment, Hazards

(Lancet. 2018;391:1197–204)

Among patients who undergo lumbar puncture, up to 35% return to the hospital with a postdural puncture headache, which is caused by continuing leakage of the cerebrospinal fluid (CSF) from the dural defect created by the spinal needle. Conventional needles are most frequently used in clinical practice by nonanesthesiologists and have a sharp slanted tip designed to cut through the dura with a distal opening for injection of drugs or collection of CSF. As these needles cut through tissues, they cause irregular lacerations that can increase the potential for CSF leakage. In contrast, atraumatic needles are blunt with a closed pencil point tip and a side port for drug injection or CSF collection. They separate and dilate dural fibers rather than cutting through the fibers; thus they have been postulated to reduce the incidence of postdural puncture headache because they limit the leakage of CSF after lumbar puncture. Although atraumatic needles are now commonly used by anesthesiologists for spinal anesthesia, they are infrequently used by other clinicians as they seem unaware of their existence. This systematic review and meta-analysis of randomized controlled trials was performed to compare atraumatic and conventional lumbar puncture needles.

Division of Neurosurgery Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada

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