Reg Anesth Pain Med. 2018 Jul;43(5):502-508. doi: 10.1097/AAP.0000000000000775.
Potentially broadened indications for spinal anesthesia require increased understanding of the risk factors and prevention measures associated with postdural puncture headache (PDPH). This review is designed to examine the association between spinal needle characteristics and incidence of PDPH.
Meta-analysis and metaregression was performed on randomized controlled trials to determine the effect of needle design and gauge on the incidence of PDPH after controlling for patient confounders such as age, sex, and year of publication.
Fifty-seven randomized controlled trials (n = 16416) were included in our analysis, of which 32 compared pencil-point design with cutting-needle design and 25 compared individual gauges of similar design. Pencil-point design was associated with a statistically significant reduction in incidence of PDPH (risk ratio, 0.41; 95% confidence interval, 0.31-0.54; P < 0.001; I = 29%) compared with cutting needles among studies that assessed both design types. Subgroup analysis among obstetric and nonobstetric procedures yielded similar results. After adjustment for significant covariates, metaregression analysis among all 57 included trials revealed a significant correlation between needle gauge and rate of PDPH among cutting needles (slope = -2.65, P < 0.001), but not pencil-point needles (slope = -0.01, P = 0.819).
Pencil-point needles are associated with significantly lower incidence of PDPH compared with the cutting-needle design. Whereas a significant relationship was noted between needle gauge and PDPH for cutting-needle design, a similar association was not shown for pencil-point needles. Providers may consider selection of larger-caliber pencil-point needle to maximize technical proficiency without expensing increased rates of PDPH.
脊髓麻醉的潜在适应证拓宽，需要增加对与硬膜穿破后头痛（PDPH）相关的危险因素和预防措施的了解。本综述旨在检查脊髓针特征与 PDPH 发生率之间的关系。
对随机对照试验进行荟萃分析和元回归分析，以确定在控制患者混杂因素（如年龄、性别和发表年份）后，针设计和规格对 PDPH 发生率的影响。
我们的分析纳入了 57 项随机对照试验（n=16416），其中 32 项比较了笔尖设计与切割针设计，25 项比较了类似设计的不同规格。与切割针相比，笔尖设计与 PDPH 发生率显著降低相关（风险比，0.41；95%置信区间，0.31-0.54；P<0.001；I=29%），在评估两种设计类型的研究中。产科和非产科手术的亚组分析得出了类似的结果。在对显著协变量进行调整后，对所有 57 项纳入试验的元回归分析显示，切割针的针规与 PDPH 发生率之间存在显著相关性（斜率=-2.65，P<0.001），但笔尖针则没有（斜率=-0.01，P=0.819）。
与切割针设计相比，笔尖针与 PDPH 发生率显著降低相关。虽然在切割针设计中，针规与 PDPH 之间存在显著关系，但在笔尖针中则没有类似的关联。提供者可能会考虑选择较大规格的笔尖针，以最大限度地提高技术熟练程度，而不会增加 PDPH 的发生率。
