title: Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache: A meta-analysis.
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.
authors.affiliation: Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin, People's Republic of China.
authors.forename: Hong
authors.initials: H
authors.lastname: Xu
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.forename: WenYe
authors.initials: W
authors.lastname: Song
authors.forename: ShunLi
authors.initials: S
authors.lastname: Kan
authors.forename: FeiFei
authors.initials: F
authors.lastname: Liu
authors.forename: Di
authors.initials: D
authors.lastname: Zhang
authors.forename: GuangZhi
authors.initials: G
authors.lastname: Ning
authors.forename: ShiQing
authors.initials: S
authors.lastname: Feng
mesh_terms: D000775:Anesthesia, Spinal / Q000295:instrumentation*; D006801:Humans; D009339:Needles; D051299:Post-Dural Puncture Headache / Q000517:prevention & control*