title: Changing the needle for lumbar punctures: results from a prospective study.
abstract: OBJECTIVE
  Post-dural puncture headache (PDPH) is a common complication of diagnostic lumbar punctures. Both a non-cutting needle design and the use of smaller size needles have been shown to greatly reduce the risk of PDPH. Nevertheless, larger cutting needles are still widely used. This study describes the process of changing the needle in an outpatient clinic of a Danish neurology department.
  
  
  METHODS
  Prospective interventional trial. Phase 1: 22G cutting needle. Phase 2: 25G non-cutting needle. Practical usability of each needle was recorded during the procedure, while the rate of PDPH and the occurrence of socioeconomic complications were acquired from a standardized questionnaire.
  
  
  RESULTS
  651 patients scheduled for diagnostic lumbar punctures were screened for participation and 501 patients were included. The response rate was 80% in both phases. In phase 2, significant reductions were observed in occurrence of PDPH (21 vs. 50, p=0.001), number of days spent away from work (55 vs. 175, p<0.001), hospitalizations (2 vs. 17, p<0.001), and number of bloodpatch treatments (2 vs. 10, p=0.019). Furthermore, during the procedure, both the need for multiple attempts (30% vs. 44%, p=0.001), and the failure-rate of the first operator (17% vs. 29%, p=0.005) were reduced.
  
  
  CONCLUSIONS
  Our study showed that smaller, non-cutting needles reduce the incidence of PDPH and are easily implemented in an outpatient clinic. Changing the needle resulted in fewer socioeconomic complications and fewer overall costs, while also reducing procedural difficulty.
authors.affiliation: Department of Neurology, Lillebaelt Hospital, Vejle, Denmark. Electronic address: tsengedal@gmail.com.
authors.forename: Thorbjørn S
authors.initials: TS
authors.lastname: Engedal
authors.affiliation: Department of Anesthesiology, Lillebaelt Hospital, Vejle, Denmark. Electronic address: oerding@dadlnet.dk.
authors.forename: Helle
authors.initials: H
authors.lastname: Ørding
authors.affiliation: Department of Neurology, Lillebaelt Hospital, Vejle, Denmark. Electronic address: ole.vilholm@rsyd.dk.
authors.forename: Ole Jakob
authors.initials: OJ
authors.lastname: Vilholm
mesh_terms: D000328:Adult; D000368:Aged; D000775:Anesthesia, Spinal / Q000706:statistics & numerical data*; D017217:Blood Patch, Epidural / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009339:Needles; D051299:Post-Dural Puncture Headache / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013129:Spinal Puncture / Q000009:adverse effects* / Q000379:methods; D011795:Surveys and Questionnaires / Q000592:standards
keywords: Headache disorders/etiology; Post-dural puncture headache; Spinal puncture/adverse effects; Spinal puncture/instrumentation; Spinal puncture/methods