Occurrence of postdural puncture headache—A randomized controlled trial comparing 22G Sprotte and Quincke

Abstract

Abstract Objective To assess the incidence of postdural puncture headache (PDPH) using 22‐gauge atraumatic needle (Sprotte, 22GS) compared with 22‐gauge traumatic needle (Quincke, 22GQ). Background Diagnostic lumbar puncture (dLP) is commonly complicated by PDPH. Despite evidence to support the use of 22GS, European neurologists seem to keep using 22GQ. Methods This was a randomized, double‐blind study. Adults (age: 18–60 years) scheduled for dLP were included. dLP and CSF acquisition were performed in accordance with highly standardized procedures. Patients were followed up on days 2 and 7. Results In total, 172 patients were randomized and lumbar punctured, and 21 were excluded due to wrong inclusion (n = 11), needle switch (n = 7), failed dLP (n = 1), withdrawal (n = 1), and missed follow‐up (n = 1). Among the remaining 151 patients (mean age: 40.7 ± 12.4 years), 77 had dLP using 22GQ and 74 using 22GS. Incidence of PDPH among patients punctured with 22GS (18%) was significantly lower (p = .004) than among patients punctured with 22GQ (39%). Relative risk was 0.45, 95% CI 0.26–0.80. Patients with PDPH had significantly lower weight (p = .035), and there was no significant difference related to age (p = .064), sex (p = .239), height (p = .857), premorbid episodic migraine (p = .829), opening pressure (p = .117), operators (p = .148), amount of CSF removed (p = .205), or number of attempts (p = .623). Conclusions The use of 22GS halves the risk of PDPH compared with 22GQ. This study provides strong support to make a change in practice where traumatic needles are still in regular use.

Keywords

• 22‐gauge Quincke (traumatic needle)
• 22‐gauge Sprotte (atraumatic needle)
• cerebrospinal fluid
• diagnostic lumbar puncture
• postdural puncture headache