Choosing the best needle for diagnostic lumbar puncture

Anderson, Mike

doi:10.1016/s0736-4679(97)86445-1

Cited by 4 publications

(9 citation statements)

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“…Der konische "atraumatische" Schliff der Spinalnadel relativiert somit den Einsatz englumiger 29 Goder 32 G-Kanülen, die zudem schwerer zu handhaben sind [44]. Carson et al [10] haben die Inzidenz des postpunktionellen Kopfschmerz in Abhängigkeit von dem verwendeten Nadeltyp bei geburtshilflichen Eingriffen zusammengefaßt. Hierbei zeigt sich eine Reduktion von 18,9 auf 6,7% im Vergleich der 22 G-Quincke-Nadel zu sogenannten "atraumatischen" Nadeln der gleichen Größe (Tabelle 2).…”

Section: Nadelschliffunclassified

“…die 20-G-Sprotte-Nadel. Für die Druckmessung oder die Sammlung kleiner Liquormengen wird die 22 G-SprotteNadel oder 22 G-Whitacre-Nadel empfohlen [10].…”

Section: Nadelschliffunclassified

“…Entscheidende Faktoren für die diagnostische Liquorpunktion ist die Flußrate, die mindestens 2 ml/min (120 ml/h) betragen sollte. Bei Messungen des Liquordruckes sollten 90% des Gesamtdruckes in weniger als 1 min korrekt angezeigt werden [10].…”

Section: Punktionsversucheunclassified

“…besser waren als die von gleich großen Nadeln mit schrägem Schliff [10]. Die besten Charakteristika aller Nadeln zeigte …”

Section: Punktionsversucheunclassified

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Postpunktioneller Kopfschmerz

et al. 1999

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Lumbar puncture (LP) is a routine technique performed for a variety of procedures, e.g. diagnosis, administration of drugs, myelography and spinal anaesthesia. Postdural puncture headache is a common complication (30-40% in diagnostic LP). Prevention can be accomplished by using small-gauge needles (< or = 25 G) or pencil-point needles (22 G). Therapy should be carried out in a stepwise approach. The first step is bedrest, use of analgetics, i.v. fluids and an adequate guidance of the patient. The second step comprises special drug therapy. Several methods of pharmacologic management have been presented in the literature, but most of these are case reports. There is a lack of large double-blind placebo-controlled studies. Theophylline, caffeine, ACTH and sumatriptan are potentially promising agents for the treatment of postdural puncture headache. The efficacy of theophylline has been proven in a double-blind and placebo-controlled study. There are a few studies and case reports reporting that caffeine p.o. and i.v. is effective in the treatment of postdural puncture headache, but recurrence of headache after caffeine therapy is frequent. ACTH acts on a complex hormonal system. The treatment with sumatriptan has been reported in only a few case reports. The third step, and one of the most effective treatments of postdural puncture headache, is the epidural blood patch. The success rate ranges between 80 and 97%.

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Section: Nadelschliffunclassified

“…die 20-G-Sprotte-Nadel. Für die Druckmessung oder die Sammlung kleiner Liquormengen wird die 22 G-SprotteNadel oder 22 G-Whitacre-Nadel empfohlen [10].…”

Section: Nadelschliffunclassified

Section: Punktionsversucheunclassified

“…besser waren als die von gleich großen Nadeln mit schrägem Schliff [10]. Die besten Charakteristika aller Nadeln zeigte …”

Section: Punktionsversucheunclassified

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Postpunktioneller Kopfschmerz

et al. 1999

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“…The reported frequency rates of PLPS range from < 1 to 70% (see [14,7] for reference). Its incidence depends on (1) age, sex, and psychological status of the patients: most often young women are affected [18]; (2) the diameter of the needle: the smaller the calibre, the lower the frequency [10,16]; (3) the shape of the needle: in comparison with the standard needle, Sprotte's "atraumatic needle" significantly reduces the frequency of PLPS [2,3,6,13]; and (4) whether diagnostic lumbar puncture (LP) is performed or spinal anaesthesia administered [4,8,14].…”

Section: Introductionmentioning

confidence: 99%

Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients

Strupp¹,

Brandt²,

Müller³

1998

Journal of Neurology

112

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The post-lumbar puncture syndrome (PLPS) can best be explained by prolonged spinal fluid leakage owing to delayed closure of a dural defect. Its incidence after spinal anaesthesia is much lower than after diagnostic lumbar puncture (LP). This difference could be caused by a strand of arachnoid, which might enter the needle with the outflowing cerebrospinal fluid (CSF) during diagnostic LP and upon removal of the needle be threaded back through the dura to produce prolonged CSF leakage. To find a technique that further reduces the incidence of PLPS, this hypothesis was tested by evaluating the effect that reinserting the stylet before removing the needle had on the incidence of PLPS. By reinserting the stylet to the tip of the needle, the hypothesized strand would be pushed out, thereby reducing the frequency of PLPS. Sprotte's "atraumatic needle" (21 gauge) was used for LP. A total of 600 patients participated in the prospective study. They were randomized into two groups and questioned about their complaints every day for up to 7 days after the LP. All LPs were performed by two experienced neurologists (T.B., M.S.). In 300 patients, the stylet was reinserted to the tip of the eedle; in the other 300 it was not reinserted. Whereas 49 of the 300 patients without reinsertion developed PLPS, only 15 of the 300 patients with reinsertion did. This significant difference (16.3 vs 5.0%, P < 0.005, chi square test) supports our hypothesis. On the basis of our results, we recommend reinserting the stylet before removing the needle in order to reduce the incidence of PLPS.

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