Salzer J, Granåsen G, Sundström P, Vågberg M, Svenningsson A
Department of Clinical Science, Neurosciences at Umeå University, Umeå.
Department of Public Health and Clinical Medicine, Umeå University, Umeå.
Eur J Neurol. 2020 May;27(5):871-877. doi: 10.1111/ene.14158. Epub 2020 Feb 20.
We investigated 952 subjects undergoing diagnostic lumbar puncture (LP) to study the effects of needle size, needle design and stylet reinsertion on the risk of post-dural puncture headache (PDPH).
This randomized double-blind study was performed at Umeå University Hospital in Sweden during 2013-2018. Subjects were randomly assigned one of three needles [22 gauge (G) atraumatic, 25G atraumatic and 25G cutting] and stylet reinsertion before needle withdrawal or not. The main outcome measure was PDPH assessed by standardized telephone interview(s) 5 days after the LP, repeated until headache cessation. We used logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CI) for PDPH.
The mean (SD) age was 51.1 (16.7) years and 53.6% were females. The smaller bore (25G) atraumatic needle incurred a lower risk of headache compared with the larger bore (22G) atraumatic needle [22.0% (69/314) vs. 30.2% (98/324); OR, 0.65; 95% CI, 0.45-0.93] and compared with the cutting needle [32.8% (103/314); OR, 0.58; 95% CI, 0.40-0.82]. Reinserting the stylet before needle withdrawal did not reduce the risk of headache.
These data suggest that a 25G atraumatic needle is superior to a larger atraumatic needle, and to a same-sized cutting needle, in preventing PDPH after diagnostic LP. In contrast to one earlier report, this study did not find that stylet reinsertion was effective in preventing PDPH. This study provides class I evidence that a small atraumatic needle decreases the risk of PDPH and that stylet reinsertion does not influence PDPH risk.
我们对952名接受诊断性腰椎穿刺（LP）的受试者进行了研究，以探讨针的尺寸、针的设计以及回插针芯对硬膜穿刺后头痛（PDPH）风险的影响。
这项随机双盲研究于2013年至2018年在瑞典于默奥大学医院进行。受试者被随机分配使用三种针中的一种[22号（G）无创伤针、25G无创伤针和25G切割针]，并在拔针前回插针芯或不回插。主要结局指标是在LP后5天通过标准化电话访谈评估的PDPH，重复进行直至头痛停止。我们使用逻辑回归计算PDPH的比值比（OR）及95%置信区间（CI）。
平均（标准差）年龄为51.1（16.7）岁，女性占53.6%。与较大孔径（22G）无创伤针相比，较小孔径（25G）无创伤针导致头痛的风险更低[22.0%（69/314）对30.2%（98/324）；OR，0.65；95%CI，0.45 - 0.93]，与切割针相比也是如此[32.8%（103/314）；OR，0.58；95%CI，0.40 - 0.82]。在拔针前回插针芯并未降低头痛风险。
这些数据表明，在诊断性LP后预防PDPH方面，25G无创伤针优于较大的无创伤针和相同尺寸的切割针。与一份早期报告不同，本研究未发现回插针芯对预防PDPH有效。本研究提供了I级证据，即小的无创伤针可降低PDPH风险，且回插针芯不影响PDPH风险。
