PDPH is still a problem.

Research indicates PDPH occurrence rates around 33% or higher in the field of radiology. This is dramatically higher when compared to other specialities that have adopted atraumatic needles.

https://www.practicalpainmanagement.com/pain/headache/preventing-post-dural-puncture-headache

PDPH is still a problem.

Research indicates PDPH occurrence rates around 33% or higher in the field of radiology. This is dramatically higher when compared to other specialities that have adopted atraumatic needles.

https://www.practicalpainmanagement.com/pain/headache/preventing-post-dural-puncture-headache

A track record of reducing PDPH

The Gertie Marx needle has been engineered to minimize PDPH and has a proven track record of <1% occurrence of PDPH when administered with proper skill and technique.

Superior design and continued enhancements to the Gertie Marx needle continue to improve procedural outcomes in the field of radiology. Our products dramatically reduce the risk of PDPH. The results are simple; improved outcomes and increased patient comfort and satisfaction.

Research offers clinicians and stakeholders a comprehensive assessment and high-quality evidence for the safety and efficacy of the Gertie Marx Needle.

There is room for improvement in the prevention and treatment of headache after lumbar puncture.

Stendell L, Fomsgaard JS, Olsen KS

Conclusions:

The incidence of post dural puncture headache (PDPH) after lumbar puncture (LP) can be reduced from 36% to 0-9% by the use of an atraumatic needle size 24 gauge (G)/0.56 mm rather than a traumatic needle size 22 G/0.7 mm.

Postdural Puncture Headache (PDPH)

Michael C. Plewa; Scott C. Dulebohn

Conclusions:

Postdural puncture headache (PDPH) is a potential expected complication of a lumbar puncture Incidence has been estimated quite variable in the literature, but may be approximately 10% to 40% of LP procedures, but can be as low as 2% when small gauge (less than or equal to 24 gauge) non-cutting needles are used.

Use of atraumatic spinal needles among neurologists in the United States.

Birnbach DJ, Kuroda MM, Sternman D, Thys DM.

Conclusions:

Atraumatic spinal needles for lumbar puncture have been shown to dramatically decrease the risk of postdural puncture headache. Although the use of these needles is standard practice among anesthesiologists, they have not been adopted by other medical specialties. This may lead to unnecessary morbidity among patients undergoing lumbar puncture.

Atraumatic lumbar puncture needles after all these years, are we still missing the point?

Katherine Arendt, Bart M Demaerschalk, Dean Marko Wingerchuk, William Camann

Abstract:

Modern cutting needles, also called Quincke needles, have an obliquely sliced tip that cuts through the dura. The pencil-point or atraumatic needle was thought to penetrate and then separate the dural fibers, resulting in a less traumatic hole and subsequent less loss of CSF and a lower incidence of PDPH.

The rate of PDPH for diagnostic lumbar puncture in an ambulatory population with a 20- or 22-gauge cutting needle is estimated to be 36%. In comparison, the rate of PDPH with a 22-gauge atraumatic needle is estimated to be less than 2%. The superiority of the atraumatic needle has also been demonstrated in a randomized trial for myelography, with fewer postmyelogram headaches observed with an atraumatic needle compared with a cutting tip design.

 

Conclusions:

The evidence that atraumatic spinal needles cause fewer PDPHs is so convincing that both the American Society of Anesthesiologists (ASA) and the American Academy of Neurology have published statements encouraging the replacement of cutting needles by atraumatic spinal needles.

Expressed differently, this evidence reveals that for every 6 neurology patients that undergo a diagnostic dural puncture with an atraumatic needle instead of a standard needle, 1 patient will Get a headache

Further, studies looking specifically at neurology patients undergoing lumbar puncture have shown a decrease from 36% to ~3%

The use of noncutting or pencil-point spinal needles should become the standard for performing diagnostic lumbar puncture.

Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache A meta-analysis

Hong Xu, MD, Yang Liu, MD, WenYe song, MD, ShunLi Kan, MD, FeiFei Liu, MD, Di Zhang, MD

Conclusions:

Current evidences suggest that the pencil-point spinal needle was significantly superior compared with cutting spinal needle regarding the frequency of PDPH, PDPH severity, and the use of EBP. In view of this, we recommend the use of pencil-point spinal needle in spinal anesthesia and lumbar puncture.

Apart from the spinal needle size, spinal needle shape might be the most important modifiable risk factors of PDPH. And we consider pencil-point spinal needle another effective way to reduce the incidence of PDPH in spinal anesthesia and lumbar puncture.