TY - JOUR
T1 - The Impact of Spinal Needle Selection on Postdural Puncture Headache
T2 - A Meta-Analysis and Metaregression of Randomized Studies
AU - Zorrilla-Vaca, Andres
AU - Mathur, Vineesh
AU - Wu, Christopher
AU - Grant, Michael C.
N1 - Funding Information:
From the *Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD; and †Faculty of Health, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia. Accepted for publication December 8, 2017. Address correspondence to: Michael C. Grant, MD, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, 1800 Orleans St, Sheikh Zayed Tower 3014C, Baltimore, MD 21287 (e‐mail: mgrant17@jhmi.edu). A.Z.-V. receives research support from the Colombian Society of Anesthesiology and Reanimation. The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.rapm.org). Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine ISSN: 1098-7339 DOI: 10.1097/AAP.0000000000000775
Publisher Copyright:
Copyright © 2018 American Society of Regional Anesthesia and Pain Medicine.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - Background and Objectives: Potentially broadened indications for spinal anesthesia require increased understanding of the risk factors and prevention measures associated with postdural puncture headache (PDPH). This review is designed to examine the association between spinal needle characteristics and incidence of PDPH. Methods: Meta-analysis and metaregression was performed on randomized controlled trials to determine the effect of needle design and gauge on the incidence of PDPH after controlling for patient confounders such as age, sex, and year of publication. Results: Fifty-seven randomized controlled trials (n = 16416) were included in our analysis, of which 32 compared pencil-point design with cutting-needle design and 25 compared individual gauges of similar design. Pencil-point design was associated with a statistically significant reduction in incidence of PDPH (risk ratio, 0.41; 95% confidence interval, 0.31-0.54; P < 0.001; I2 = 29%) compared with cutting needles among studies that assessed both design types. Subgroup analysis among obstetric and nonobstetric procedures yielded similar results. After adjustment for significant covariates, metaregression analysis among all 57 included trials revealed a significant correlation between needle gauge and rate of PDPH among cutting needles (slope = -2.65, P < 0.001), but not pencil-point needles (slope = -0.01, P = 0.819). Conclusions: Pencil-point needles are associated with significantly lower incidence of PDPH compared with the cutting-needle design. Whereas a significant relationship was noted between needle gauge and PDPH for cutting-needle design, a similar association was not shown for pencil-point needles. Providers may consider selection of larger-caliber pencil-point needle to maximize technical proficiency without expensing increased rates of PDPH.
AB - Background and Objectives: Potentially broadened indications for spinal anesthesia require increased understanding of the risk factors and prevention measures associated with postdural puncture headache (PDPH). This review is designed to examine the association between spinal needle characteristics and incidence of PDPH. Methods: Meta-analysis and metaregression was performed on randomized controlled trials to determine the effect of needle design and gauge on the incidence of PDPH after controlling for patient confounders such as age, sex, and year of publication. Results: Fifty-seven randomized controlled trials (n = 16416) were included in our analysis, of which 32 compared pencil-point design with cutting-needle design and 25 compared individual gauges of similar design. Pencil-point design was associated with a statistically significant reduction in incidence of PDPH (risk ratio, 0.41; 95% confidence interval, 0.31-0.54; P < 0.001; I2 = 29%) compared with cutting needles among studies that assessed both design types. Subgroup analysis among obstetric and nonobstetric procedures yielded similar results. After adjustment for significant covariates, metaregression analysis among all 57 included trials revealed a significant correlation between needle gauge and rate of PDPH among cutting needles (slope = -2.65, P < 0.001), but not pencil-point needles (slope = -0.01, P = 0.819). Conclusions: Pencil-point needles are associated with significantly lower incidence of PDPH compared with the cutting-needle design. Whereas a significant relationship was noted between needle gauge and PDPH for cutting-needle design, a similar association was not shown for pencil-point needles. Providers may consider selection of larger-caliber pencil-point needle to maximize technical proficiency without expensing increased rates of PDPH.
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U2 - 10.1097/AAP.0000000000000775
DO - 10.1097/AAP.0000000000000775
M3 - Article
C2 - 29659437
AN - SCOPUS:85049400978
SN - 1098-7339
VL - 43
SP - 502
EP - 508
JO - Regional anesthesia and pain medicine
JF - Regional anesthesia and pain medicine
IS - 5
ER -