Time to Switch to Atraumatic Lumbar-Puncture Needles: Meta-analysis

By Lorraine L. Janeczko

December 21, 2017

NEW YORK (Reuters Health) - Atraumatic lumbar puncture needles are safe and effective, and they cause fewer postdural-puncture headaches and returns to the hospital for additional treatment, according to a systematic review and meta-analysis.

"This study, based on a total of 110 trials including more than 30,000 patients shows that atraumatic needles decrease the risk of complications, including headaches and patient returning to hospital for narcotics and blood patches, by more than 50%. Also, they're as easy to use as the conventional ones," senior author Dr. Saleh A. Almenawer of Hamilton Health Sciences and McMaster University in Hamilton, Canada, told Reuters Health by email.

But "multiple surveys show that only around 5% of practitioners use atraumatic needles," he said.

As they report in The Lancet, online December 6, Dr. Almenawer and colleagues conducted a systematic review and meta-analysis to compare patient outcomes after lumbar puncture with atraumatic needles versus conventional needles.

The researchers searched 13 databases with no language restrictions from inception to Aug 15, 2017, for randomized controlled trials comparing the use of atraumatic needles and conventional needles for any lumbar puncture indication. They excluded randomized trials in which no dural puncture was performed (epidural injections) and those without a conventional needle control group.

The team analyzed data from 110 trials from 29 countries conducted between 1989 and 2017, including a total of 31,412 participants.

Postdural-puncture headache incidence dropped significantly from 11.0% in the conventional needle group to 4.2% in the atraumatic group. Atraumatic needles were also associated with significant decreases in the need for intravenous fluid or controlled analgesia; the need for epidural blood patch; any headache, mild headache, severe headache; nerve root irritation; and hearing disturbance.

Lumbar puncture success on the first attempt, failure rate, average number of attempts, and incidence of traumatic tap and backache were similar with the two needle types. Subgroup analyses of postdural-puncture headache showed no interactions between needle type and patient sex, age, position, bed rest after puncture, needle gauge, indication for lumbar puncture, use of intravenous fluid, or clinician specialty.

Dr. Matthijs C. Brouwer, an associate professor in the Department of Neurology at the Academic Medical Centre, University of Amsterdam, in the Netherlands, told Reuters Health by email, “The findings of the study are to some extent surprising. We already knew that atraumatic needles had fewer complications, but the magnitude of the effect was larger than we expected. This really shows that we should switch to atraumatic needles.”

“This should change clinical practice and result in fewer patients with lumbar puncture complications. Especially the frequency of post-lumbar puncture headache will decrease, and the number of hospital readmissions or epidural blood patches for this complication will be strongly reduced," added Dr. Brouwer, who co-wrote an editorial about the study.

"The answer to the question, 'Are atraumatic needles better for lumbar punctures?' is now answered with a clear 'Yes,'" he added.

Dr. Almenawer explained that "atrauamtic needles were invented more than 70 years ago, yet most clinicians (95% according to surveys) still use the conventional needles. Lumbar puncture is an extremely common procedure, and the strong results from this study call for switching the type of needle."

"Lumbar puncture was invented by Dr. Heinrich Quincke in 1890," he noted. "We still use the same needle used by him. It is time to change the needle for the benefit of patients."

SOURCES: https://bit.ly/2BDgfLZ and https://bit.ly/2B5cJJ7

Lancet 2017.

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