BMJ 2000;321:986-990 ( 21 October )

Papers

Randomised controlled trial of atraumatic versus standard needles for diagnostic lumbar puncture

Editorial by Serpell and Rawal

S Rachel Thomas, lecturer, ^a D R S Jamieson, consultant, ^b Keith W Muir, locum consultant. ^a

^a Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, ^b Department of Neurology, Leeds General Infirmary, Leeds LS1 3EX

Correspondence to: K W Muir k.muir{at}clinmed.gla.ac.uk

Objective: To compare the ease of use of atraumatic needles with standard needles for diagnostic lumbar puncture and the incidence of headache after their use.
Design: Double blind, randomised controlled trial.
Setting: Investigation ward of a neurology unit in a university hospital.
Participants: 116 patients requiring elective diagnostic lumbar puncture.
Interventions: Standardised protocol for lumbar puncture with 20 gauge atraumatic or standard needles.
Outcome measures: The primary end point was intention to treat analysis of incidence of moderate to severe headache, assessed at one week by telephone interview. Secondary end points were incidence of headache at one week analysed by needle type, ease of use by operator according to a visual analogue scale, incidence of backache, and failure rate of puncture.
Results: Valid outcome data were available for 97 of 101 patients randomised. Baseline characteristics were matched except for higher body mass index in the standard needle group. By an intention to treat analysis the absolute risk of moderate to severe headache with atraumatic needles was reduced by 26% (95% confidence interval 6% to 45%) compared with standard needles, but there was a non-significantly greater absolute risk of multiple attempts at lumbar puncture (14%, 4% to 32%). Higher body mass index was associated with an increased failure rate with atraumatic needles, but the reduced incidence of headache was maintained. The need for medical interventions was reduced by 20% (1% to 40%).
Conclusions: Atraumatic needles significantly reduced the incidence of moderate to severe headache and the need for medical interventions after diagnostic lumbar punctures, but they were associated with a higher failure rate than standard needles.

---

© BMJ 2000
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Headache after diagnostic lumbar puncture

James S Smeltzer, John R Davies, David Turnbull, Fiona McKevitt, Keith W Muir, and Susannah Baron
BMJ 2001 322: 993. [Extract] [Full Text]

Innovation
BMJ 2000 321: 0. [Full Text] [PDF]

Innovation
BMJ 2000 321: 0. [Full Text] [PDF]

Atraumatic needles reduce incidence of headaches after lumbar puncture
BMJ 2000 321: 0. [Full Text]

Headaches after diagnostic dural punctures

M G Serpell and Narinder Rawal
BMJ 2000 321: 973-974. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Yu, S.D., Chen, M.Y., Johnson, A.J. (2009). Factors Associated with Traumatic Fluoroscopy-Guided Lumbar Punctures: A Retrospective Review. Am. J. Neuroradiol. 30: 512-515 [Abstract] [Full text]  
• Lee, L. C.-Y., Sennett, M., Erickson, J. M. (2007). Prevention and Management of Post-Lumbar Puncture Headache in Pediatric Oncology Patients. Journal of Pediatric Oncology Nursing 24: 200-207 [Abstract]  
• Straus, S. E., Thorpe, K. E., Holroyd-Leduc, J. (2006). How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis?. JAMA 296: 2012-2022 [Abstract] [Full text]  
• Lavi, R., Yernitzky, D., Rowe, J. M., Weissman, A., Segal, D., Avivi, I. (2006). Standard vs atraumatic Whitacre needle for diagnostic lumbar puncture: A randomized trial. Neurology 67: 1492-1494 [Abstract] [Full text]  
• Turnbull, D. K., Shepherd, D. B. (2003). Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 91: 718-729 [Abstract] [Full text]  
• Strupp, M., Schueler, O., Straube, A., Von Stuckrad-Barre, S., Brandt, T. (2001). ""Atraumatic"" Sprotte needle reduces the incidence of post-lumbar puncture headaches. Neurology 57: 2310-2312 [Abstract] [Full text]  
• Smeltzer, J. S, Davies, J. R, Turnbull, D., McKevitt, F., Muir, K. W, Baron, S. (2001). Headache after diagnostic lumbar puncture. BMJ 322: 993b-993 [Full text]  
• (2000). Atraumatic Needles Lower Incidence of Headache After Spinal Tap. JWatch General 2000: 7-7 [Full text]  
• Serpell, M G, Rawal, N. (2000). Headaches after diagnostic dural punctures. BMJ 321: 973-974 [Full text]  

Rapid Responses:

Read all Rapid Responses

Gunning for headaches

James S Smeltzer
bmj.com, 23 Oct 2000 [Full text]

Things known about this subject: smaller is better

J R Davies
bmj.com, 25 Oct 2000 [Full text]

Authors' reply

Keith W Muir
bmj.com, 28 Oct 2000 [Full text]

Atraumatic versus standard needles for diagnostic lumbar puncture

Ella Checkley
bmj.com, 7 Nov 2000 [Full text]

diagnostic lumbar puncture

David Turnbull
bmj.com, 22 Nov 2000 [Full text]

Atraumatic needle - gauge factors

Fraser M J Harban, et al.
bmj.com, 26 Apr 2001 [Full text]

Online poll

Find out more on doc2doc >>