Needle Bevel Direction and Headache after Inadvertent Dural Puncture

Norris, Mark C.; Leighton, Barbara L.; DeSimone, Cheryl A.

doi:10.1097/00000542-198905000-00002

Cited by 157 publications

(64 citation statements)

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“…Thirty-nine studies (16 RCT, [10][11][12]14,[16][17][18][19][20][21]23,24,26,[28][29][30] ten cohort studies, [33][34][35][36][38][39][40][41][42][43] and 13 case series 45,[47][48][49][50][51][53][54][55][56][57][58][59][60] ) contained data on frequency of ADP or PDPH (Table I). Figures 1 to 3 summarize the meta-analyses of ADP and PDPH risks for different epidural and spinal needles.…”

Section: Dp and Pdph Ratesmentioning

confidence: 99%

PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies

Choi

Galinski

Takeuchi

et al. 2003

Can J Anesth/J Can Anesth

328

182

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P Pu ur rp po os se e: : Postdural puncture headache (PDPH) is an iatrogenic complication of neuraxial blockade. We systematically reviewed the literature on parturients to determine the frequency, onset, and duration of PDPH. M Me et th ho od ds s: :Citations on PDPH in the obstetrical population were identified by computerized searches, citation review, and hand searches of abstracts and conference proceedings. Citations were included if they contained extractable data on frequency, onset, or duration of PDPH. Using meta-analysis, we calculated pooled estimates of the frequency of accidental dural puncture for epidural needles and pooled estimates of the frequencies of PDPH for epidural and spinal needles.R Re es su ul lt ts s: : Parturients have approximately a 1.5% [95% confidence interval (CI) 1.5% to 1.5%) risk of accidental dural puncture with epidural insertion. Of these, approximately half (52.1%; 95% CI, 51.4% to 52.8%) will result in PDPH. The risk of PDPH from spinal needles diminishes with small diameter, atraumatic needles, but is still appreciable (Whitacre 27-gauge needle 1.7%; 95% CI, 1.6% to 1.8%). PDPH occurs as early as one day and as late as seven days after dural puncture and lasts 12 hr to seven days. C Co on nc cl lu us si io on n: : PDPH is a common complication for parturients undergoing neuraxial blockade. Objectif : Les céphalées post-ponction durale (CPPD) sont une complication iatrogène du bloc neuraxial. Une revue systématique des publications sur les parturientes a permis de déterminer la fréquence, le délai d'installation et la durée des CPPD. Méthode : Les citations sur les CPPD dans la population obstétricale ont été repérées par des recherches informatisées, la revue des références et des recherches manuelles de résumés et de comptes rendus de conférences. Les références retenues devaient comporter des données sur la fréquence, le délai d'installation et la durée des

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Section: Dp and Pdph Ratesmentioning

confidence: 99%

PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies

Choi

Galinski

Takeuchi

et al. 2003

Can J Anesth/J Can Anesth

328

182

View full text Add to dashboard Cite

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“…24 When the dura is punctured with the bevel perpendicular to the fibers, more fibers are severed than when the bevel is parallel to the fibers. 21 Five studies of patients receiving spinal anesthesia have demonstrated a reduction in the incidence of PLPHA by 50% or greater when the bevel is parallel rather than perpendicular. 17,[20][21][22][23] …”

Section: Direction Of Bevelmentioning

confidence: 99%

“…Direction of bevel: There is Class I evidence in anesthesiology literature that less incidence of PLPHA results if the bevel of the Quincke is inserted parallel to the dural fibers, rather than perpendicular. 17,[20][21][22][23] Parallel insertion means that a plane passing through the flat part of the bevel, going through both edges of the bevel, is parallel to the long or vertical axis of the spine. The dural fibers run parallel to the long axis of the spine.…”

mentioning

confidence: 99%

Assessment: Prevention of post–lumbar puncture headaches

Evans¹,

Armon²,

Frohman³

et al. 2000

Neurology

246

136

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Headache (HA) is a common sequel to lumbar puncture (LP), whether performed for diagnosis or anesthesia. [1][2][3][4][5][6] In their monograph summarizing the world literature through 1960, Tourtellotte et al.1 considered separately three principal patient populations: 1) patients undergoing diagnostic LPs (excluding myelography, pneumoencephalography, and cisternal puncture), excluding also patients whose condition might reduce the reliability to report HA; 2) patients undergoing nonobstetric spinal anesthesia; and 3) patients undergoing obstetric spinal anesthesia. They reported several observations.1. The average frequency of post-LP HAs (PLPHA) in patients after diagnostic LP (excluding myelography, pneumoencephalography, and cisternal puncture), excluding also patients whose condition might reduce the reliability to report HA, was 32%. For nonobstetric spinal anesthesia, the average frequency was 13%. For obstetric spinal anesthesia, the average frequency was 18%. 2. In reports in which patients received special measures to prevent PLPHA, the average frequencies were 6% for diagnostic LPs, 5.5% for nonobstetric spinal anesthesia, and 6.2% for obstetric spinal anesthesia. The actual frequencies in individual series ranged from 0 to 18%. 3. The frequency of PLPHA was 36% in their own series of 105 normal individuals, 30% in 317 patients with diagnostic LPs, and 2% definite and 2% probable in 100 patients undergoing spinal anesthesia (but 30 patients with HAs of other types were excluded from the latter count).In analyzing risk factors for PLPHA, they concluded that the evidence, including their own prospective series, was convincing to consider younger age and female gender as definite risk factors. They attributed the difference of PLPHAs in obstetric and nonobstetric patients undergoing spinal anesthesia at least in part to these factors. They further considered the data fairly convincing that the smaller the needle size, the lower the frequency of PLPHA, but were unable to show this in their prospective series. They commented that the great variability of HA frequency for the same needle size between authors may reduce the reliability of this observation. With regard to all other risk factors, they concluded that the evidence was inconclusive. With regard to all preventive or therapeutic measures, they commented that proponents of a particular treatment, in general, found it to be beneficial; however, some of the reports were uncontrolled and some results could not be replicated by others. Today, we would consider the latter findings a result of publication bias-if one first tried a new approach to reducing the incidence of PLPHA, one would be less likely to publish a failure than a success.They commented on the different frequency of PLPHA in patients undergoing diagnostic LP compared with those undergoing spinal anesthesia, and considered the following factors in their series: age, gender, needle size, fasting, hydration, premedication and postoperative medication, minimal amount of trauma to the meninge...

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“…Norris, Leighton and DeSimone demonstrated that identifying the extradural space when the needle bevel is orientated parallel to the longitudinal fibres significantly reduced the risk of PDPH if dural puncture occurred but, because of the large size of the needles used, PDPH is a common complication of dural puncture even with this more suitable technique [2]. When conservative treatment fails, EBP is recommended [3].…”

Section: Discussionmentioning

confidence: 99%