Comparison of Cutting and Pencil-point Spinal Needle in Spinal Anesthesia Regarding Postdural Puncture Headache: A Meta-analysis

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2017 Apr 7

PMID 28383416

Citations 15

Authors

Hong Xu

Yang Liu

Wenye Song

Shunli Kan

Feifei Liu

Di Zhang

Guangzhi Ning

Shiqing Feng

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

The Effects of Aromatherapy With Clove and Lavender on Headache Caused by Spinal Anesthesia in Patients Undergoing Urological Surgery: A Randomized Clinical Trial Study.

Dehghan M, Samareh Fekri A, Rashidipour N, Naeimi Bafghi N, Maghfouri A, Ebadzadeh M Health Sci Rep. 2025; 8(2):e70392.

PMID: 40012817 PMC: 11861026. DOI: 10.1002/hsr2.70392.

Efficacy and potency of sphenopalatine ganglion block for the management of postdural puncture headaches in post-cesarean section: A case report and literature review.

Hara M, Furuya K, Kishida K, Yamashita S, Kobayashi S, Ogita K J Obstet Gynaecol Res. 2024; 50(12):2357-2361.

PMID: 39400462 PMC: 11608840. DOI: 10.1111/jog.16121.

Risk Factors in Administering Spinal Anesthesia: A Comprehensive Review.

Doelakeh E, Chandak A Cureus. 2024; 15(12):e49886.

PMID: 38174200 PMC: 10762496. DOI: 10.7759/cureus.49886.

Incidence and Severity of Post-dural Puncture Headache in Non-obstetric Patients Undergoing Subarachnoid Block.

Aniceto L, Goncalves L, Goncalves L, Alves R, Goncalves D, Laranjo M Cureus. 2023; 15(10):e47442.

PMID: 38022139 PMC: 10659818. DOI: 10.7759/cureus.47442.

Spinal Introducer Needle Breakage During Spinal Anesthesia for Cesarean Section: A Case Report.

Sobot Novakovic S, Rakanovic D, Milic-Radic T Cureus. 2023; 15(10):e46972.

PMID: 38021597 PMC: 10640857. DOI: 10.7759/cureus.46972.

References

Flaatten H, Felthaus J, Kuwelker M, Wisborg T . Postural post-dural puncture headache. A prospective randomised study and a meta-analysis comparing two different 0.40 mm O.D. (27 g) spinal needles. Acta Anaesthesiol Scand. 2000; 44(6):643-7. DOI: 10.1034/j.1399-6576.2000.440603.x. View

Kuntz K, Kokmen E, Stevens J, Miller P, Offord K, Ho M . Post-lumbar puncture headaches: experience in 501 consecutive procedures. Neurology. 1992; 42(10):1884-7. DOI: 10.1212/wnl.42.10.1884. View

Lynch J, Kasper S, Strick K, Topalidis K, Schaaf H, Zech D . The use of Quincke and Whitacre 27-gauge needles in orthopedic patients: incidence of failed spinal anesthesia and postdural puncture headache. Anesth Analg. 1994; 79(1):124-8. DOI: 10.1213/00000539-199407000-00023. View

Wadud R, Laiq N, Qureshi F, Jan A . The frequency of postdural puncture headache in different age groups. J Coll Physicians Surg Pak. 2006; 16(6):389-92. DOI: 6.2006/JCPSP.389392. View

Carrie L, Collins P . 29-gauge spinal needles. Br J Anaesth. 1991; 66(1):145-6. DOI: 10.1093/bja/66.1.145-a. View

Kuusniemi K, Leino K, Lertola K, Pihlajamaki K, Pitkanen M . Comparison of two spinal needle types to achieve a unilateral spinal block. J Anesth. 2012; 27(2):224-30. DOI: 10.1007/s00540-012-1496-1. View

Taivainen T, Pitkanen M, Tuominen M, Rosenberg P . Efficacy of epidural blood patch for postdural puncture headache. Acta Anaesthesiol Scand. 1993; 37(7):702-5. DOI: 10.1111/j.1399-6576.1993.tb03793.x. View

Pan P, Fragneto R, Moore C, Ross V . Incidence of postdural puncture headache and backache, and success rate of dural puncture: comparison of two spinal needle designs. South Med J. 2004; 97(4):359-63. DOI: 10.1097/01.SMJ.0000078681.07409.F7. View

Naulty J, Hertwig L, Hunt C, Datta S, OSTHEIMER G, Weiss J . Influence of local anesthetic solution on postdural puncture headache. Anesthesiology. 1990; 72(3):450-4. DOI: 10.1097/00000542-199003000-00010. View

10.

de Swiet M . Maternal mortality: confidential enquiries into maternal deaths in the United Kingdom. Am J Obstet Gynecol. 2000; 182(4):760-6. DOI: 10.1016/s0002-9378(00)70324-3. View

11.

VANDAM L, DRIPPS R . Long-term follow-up of patients who received 10,098 spinal anesthetics; syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties). J Am Med Assoc. 1956; 161(7):586-91. DOI: 10.1001/jama.1956.02970070018005. View

12.

Amorim J, Gomes de Barros M, Valenca M . Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia. 2012; 32(12):916-23. DOI: 10.1177/0333102412453951. View

13.

Devcic A, Sprung J, Patel S, Kettler R . PDPH in obstetric anesthesia: comparison of 24-gauge Sprotte and 25-gauge Quincke needles and effect of subarachnoid administration of fentanyl. Reg Anesth. 1993; 18(4):222-5. View

14.

Abouleish E, Mitchell M, Taylor G, Miller H, Warters D, RASHAD M . Comparative flow rates of saline in commonly used spinal needles including pencil-tip needles. Reg Anesth. 1994; 19(1):34-42. View

15.

Bezov D, Lipton R, Ashina S . Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache. 2010; 50(7):1144-52. DOI: 10.1111/j.1526-4610.2010.01699.x. View

16.

Santanen U, Rautoma P, Luurila H, Erkola O, Pere P . Comparison of 27-gauge (0.41-mm) Whitacre and Quincke spinal needles with respect to post-dural puncture headache and non-dural puncture headache. Acta Anaesthesiol Scand. 2004; 48(4):474-9. DOI: 10.1111/j.0001-5172.2004.00345.x. View

17.

Imarengiaye C, Edomwonyi N . Evaluation of 25-gauge Quincke and 24-gauge Gertie Marx needles for spinal anaesthesia for caesarean section. East Afr Med J. 2003; 79(7):379-81. DOI: 10.4314/eamj.v79i7.8843. View

18.

Lybecker H, Moller J, May O, Nielsen H . Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias. Anesth Analg. 1990; 70(4):389-94. DOI: 10.1213/00000539-199004000-00008. View

19.

Corbey M, Bach A, Lech K, Frorup A . Grading of severity of postdural puncture headache after 27-gauge Quincke and Whitacre needles. Acta Anaesthesiol Scand. 1997; 41(6):779-84. DOI: 10.1111/j.1399-6576.1997.tb04783.x. View

20.

Shutt L, Valentine S, Wee M, Page R, Prosser A, Thomas T . Spinal anaesthesia for caesarean section: comparison of 22-gauge and 25-gauge Whitacre needles with 26-gauge Quincke needles. Br J Anaesth. 1992; 69(6):589-94. DOI: 10.1093/bja/69.6.589. View