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We read with interest the case of a post lumbar puncture headache[1]
and wish to raise an issue not covered in the discussion - that of
prevention.
In anaesthesia there has been great interest in reducing the
incidence of post dural puncture headache and, with the introduction of
smaller atraumatic needles (such as a 25G Whitacre pencil point), this has
been reduced from approximately 36% to less than 1%[2]. Despite numerous
papers highlighting the benefits of these needles outside of the operating
theatre it is disappointing that "large" bore cutting needles such as the
22G Quinke are still popular in many hospitals[3]. We feel that concerns
regarding low flow rates and the inability to accurately measure pressure
are invalid in many acutely ill patients and that many junior doctors are
unaware of the range of spinal needles available.
An educational article in the BMJ would have been an excellent forum
in which to emphasise methods of avoiding this distressing and
debilitating complication.
References:
1. Intractable headache after lumbar puncture BMJ 2011; 343:d4529
2. Post dural puncture headache: pathogenesis, prevention and
treatment Br. J. Anaesth. (2003) 91(5): 718-729 doi:10.1093/bja/aeg231
3. Lumbar Puncture: It Is Time to Change the Needle.
Eur Neurol 2010;64:108-113
Competing interests:
No competing interests
17 October 2011
Alistair Johnstone
Specialist Trainee Anaesthesia and ITU
Aidan Marsh
Dept of Anaesthesia, Frenchay Hospital, North Bristol NHS Trust
Headache after lumbar puncture - avoiding an intractable problem?
Sir,
We read with interest the case of a post lumbar puncture headache[1]
and wish to raise an issue not covered in the discussion - that of
prevention.
In anaesthesia there has been great interest in reducing the
incidence of post dural puncture headache and, with the introduction of
smaller atraumatic needles (such as a 25G Whitacre pencil point), this has
been reduced from approximately 36% to less than 1%[2]. Despite numerous
papers highlighting the benefits of these needles outside of the operating
theatre it is disappointing that "large" bore cutting needles such as the
22G Quinke are still popular in many hospitals[3]. We feel that concerns
regarding low flow rates and the inability to accurately measure pressure
are invalid in many acutely ill patients and that many junior doctors are
unaware of the range of spinal needles available.
An educational article in the BMJ would have been an excellent forum
in which to emphasise methods of avoiding this distressing and
debilitating complication.
References:
1. Intractable headache after lumbar puncture BMJ 2011; 343:d4529
2. Post dural puncture headache: pathogenesis, prevention and
treatment Br. J. Anaesth. (2003) 91(5): 718-729 doi:10.1093/bja/aeg231
3. Lumbar Puncture: It Is Time to Change the Needle.
Eur Neurol 2010;64:108-113
Competing interests: No competing interests