The Significance of Age, Sex, and Cerebrospinal Fluid Pressure in Post-Lumbar-Puncture Headache

Vilming, Steinar T; Schrader, Harald; Monstad, Iril

doi:10.1046/j.1468-2982.1989.0902099.x

Cited by 39 publications

(41 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[7,9,43–45] It is more common in reproductive age group and pregnant females. [35] Of the 25 RCTs, 9 [20,26,30,33–35,38,40,41] were performed in obstetric patients.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

Background:Postdural puncture headache (PDPH), mainly resulting from the loss of cerebral spinal fluid (CSF), is a well-known iatrogenic complication of spinal anesthesia and diagnostic lumbar puncture. Spinal needles have been modified to minimize complications. Modifiable risk factors of PDPH mainly included needle size and needle shape. However, whether the incidence of PDPH is significantly different between cutting-point and pencil-point needles was controversial. Then we did a meta-analysis to assess the incidence of PDPH of cutting spinal needle and pencil-point spinal needle.Methods:We included all randomly designed trials, assessing the clinical outcomes in patients given elective spinal anesthesia or diagnostic lumbar puncture with either cutting or pencil-point spinal needle as eligible studies. All selected studies and the risk of bias of them were assessed by 2 investigators. Clinical outcomes including success rates, frequency of PDPH, reported severe PDPH, and the use of epidural blood patch (EBP) were recorded as primary results. Results were evaluated using risk ratio (RR) with 95% confidence interval (CI) for dichotomous variables. Rev Man software (version 5.3) was used to analyze all appropriate data.Results:Twenty-five randomized controlled trials (RCTs) were included in our study. The analysis result revealed that pencil-point spinal needle would result in lower rate of PDPH (RR 2.50; 95% CI [1.96, 3.19]; P < 0.00001) and severe PDPH (RR 3.27; 95% CI [2.15, 4.96]; P < 0.00001). Furthermore, EBP was less used in pencil-point spine needle group (RR 3.69; 95% CI [1.96, 6.95]; P < 0.0001).Conclusions:Current evidences suggest that 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.

show abstract

“…[7,9,43–45] It is more common in reproductive age group and pregnant females. [35] Of the 25 RCTs, 9 [20,26,30,33–35,38,40,41] were performed in obstetric patients.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Some investigators conclude that PLPH is more common in young women with lower body mass index (BMI) and some did not find a correlation between BMI and the incidence of PLPH [18,19,20,21]. However, patients who suffered from previous PLPH are more likely to develop another PLPH following LP [22,23,24,25,26], and PLPH is less frequent in young children (<13 years) and elderly adults (>60 years) [20].…”

Section: Factors Affecting Plphmentioning

confidence: 99%

Lumbar Puncture: It Is Time to Change the Needle

2010

View full text Add to dashboard Cite

Lumbar puncture is a frequent procedure performed by physicians from several disciplines to help establish a diagnosis and treatment for several diseases. Post-lumbar puncture headache (PLPH) is a frequent complication that typically lasts for a couple of days and can be severe enough to immobilize the patient and to require therapy. There are several risk factors identified, pain characteristics, and characteristic findings on spinal and head magnetic resonance imaging. There are several procedural factors that have been identified to be of consequence in attenuating the PLPH incidence, specifically the needle type and size used for this procedure. Once PLPH occurs, the clinician should treat it conservatively with bed rest, analgesics and increased fluids intake, especially caffeine-containing beverages, as it can dramatically affect the patient’s wellness. If the pain is severe and disabling and does not respond to conservative treatment, a blood patch should be considered at least 24–48 h following the LP. Epidural blood patch is a safe and rapidly effective treatment in experienced hands. Furthermore, patients who developed PLPH should be advised to contact the medical staff in case of changes in the characteristics of headaches. When a patient who was diagnosed with PLPH has a change in the pain character, or additional neurological manifestations appear, an urgent brain CT/head MRI should be performed to exclude rarer life-threatening intracranial complications.

show abstract

“…[3][4][5] Sometimes, patients may also experience blurred vision or diplopia. 3 Various pathophysiologic mechanisms have been hypothesized for PDPH, [7][8][9][10][11] and retrospective observational studies suggest young age, [12][13][14][15][16][17][18][19] female sex, 17,[19][20][21] low body mass index (BMI), 19,22 previous PDPH, 7,18 and (migraine) headache before LP 6,23-25 as risk factors. 3 Various pathophysiologic mechanisms have been hypothesized for PDPH, [7][8][9][10][11] and retrospective observational studies suggest young age, [12][13][14][15][16][17][18][19] female sex, 17,[19][20][21] low body mass index (BMI), 19,22 previous PDPH, 7,18 and (migraine) headache before LP 6,23-25 as risk factors.…”

mentioning

confidence: 99%