Postdural Puncture Headache

Postdural Puncture Headache

A puncture needle is a type of medical needle that has a sharp tip. Puncture needles are used to take blood, inject medication or perform other tests. They are usually made of a thin metal, such as stainless steel or titanium. Some are one-part needles, while others have a sheath that holds an inner stylet. Sheathed needles are sometimes called “twist” needles. A puncture needle can be used to puncture the skin, but it is more commonly used to perform a test on fluid in the body. This test is called a lumbar puncture (spinal tap). A lumbar puncture is an examination that involves inserting a needle into the space between two bones in the lower part of the spine, or lumbar vertebrae. This needle takes a sample of cerebrospinal fluid, which is the liquid that surrounds the brain and spinal cord. The lumbar puncture can help doctors diagnose infections, diseases of the central nervous system, such as Guillain-Barre syndrome and multiple sclerosis; bleeding; or cancers of the brain or spinal cord. It may also be used to administer medicine or anesthetic agents.

A complication of a lumbar puncture is pain after the procedure, which is called a “postdural puncture headache.” This is a type of pain that radiates from the site of the needle in the back. It can be a significant problem, especially in patients with liver cirrhosis, who are at increased risk of developing this type of pain. The cause of postdural-puncture headache is thought to be due to the leakage of cerebrospinal fluid from the needle hole after the puncture and into the epidural space, which can be compressed by the peritoneum.

To decrease the incidence of this complication, a new type of needle with a hard plastic sheath and plastic wings was developed. We compared this new needle with a conventional puncture needle in patients undergoing US-guided paracentesis for ascites. The results showed that the new needle reduced the rate of repuncture and prolonged the duration of the US-guided therapeutic paracentesis without complications.

We did a retrospective study of 82 patients who underwent US-guided paracentesis with the new puncture needle and 55 patients who underwent the same procedure with a routinely used puncture needle. The success of lumbar puncture on the first attempt, failure rate, mean number of attempts, and incidence of traumatic tap and backache did not differ significantly between groups. Prespecified subgroup analyses of factors associated with repuncture revealed that the use of the new puncture needle was the only factor that decreased the rate of repuncture. This new puncture needle has a sheath with plastic wings that protect the puncture hole and prevent kinking of the sheath during drainage. This can decrease the rate of repuncture and improve the success of lumbar puncture and US-guided therapeutic paracentesis in patients with ascites caused by liver cirrhosis and other non-cirrhotic causes, such as malignancy and pancreatic disease. No additional benefits of the new puncture needle were observed, but its use is recommended for lowering the incidence of painful complications from lumbar punctures.