Removing the headache of lumbar punctures

#MS Research #MSBlog. Reduce lumbar puncture headaches. Ask for a Sprotte!

Davis A, Dobson R, Kaninia S, Espasandin M, Berg A, Giovannoni G, Schmierer K. Change practice now! Using atraumatic needles to prevent post lumbar puncture headache. Eur J Neurol. 2013. doi: 10.1111/ene.12307. [Epub ahead of print]
BACKGROUND AND PURPOSE:Lumbar puncture (LP) is a key diagnostic procedure in medicine. Post lumbar puncture headache (PLPHA) is a well recognized complication of LP. Evidence suggests that using atraumatic needles for diagnostic LP (ATNLP) reduces risk of PLPHA. However, clinicians in Europe and the USA routinely use traumatic needles for diagnostic LP (TNLP). The occurrence of PLPHA following ATNLP and TNLP was compared in a clinical setting. Further, a survey was performed exploring use of ATNLP amongst UK neurologists.
METHODS: Service development study. Patients were followed up 2 and 7 days after LP using blinded telephone assessment. A questionnaire was developed to assess use of ATNLP amongst UK neurologists. Frequency, onset, duration and severity of PLPHA were recorded as were use of analgesia, general practitioner consultations, hospital readmissions, days off work due to PLPHA and cost. Neurologists were asked about their familiarity with, and use of, ATNLP.
RESULTS:  One hundred and nine participants attending the Royal London Hospital were included, and 74 attendees of the Association of British Neurologists 2012 conference completed an on-site questionnaire. ATNLP reduced the rate of PLPHA (27.1% vs. 60.4%; P < 0.01). In those participants who developed PLPHA symptoms were short lived (mean 50 h vs. 94 h, P = 0.02) and less severe after ATNLP. Use of ATNLP led to significant cost savings. Only one in five UK neurologists regularly use ATNLP stating lack of training and availability of atraumatic needles as main reasons.
CONCLUSIONS: ATNLP significantly reduces the risk of PLPHA. Training is required to facilitate a change from TNLP to ATNLP amongst clinicians.

One of the bad experiences of a lumbar puncture is a headache, which can be a terrible experience that means you never want to have another.

As prelude to PROXIMUS we have been assessing the impact of choice of needle on lumbar puncture headaches. The Quincke needle is cutting and leaves hole for CSF to leak from which increases the risk of a head ache. The non-cutting needle(Sprotte) does not to the same extent and significantly reduces them. The sprotte currently costs about 30 times more than a 25p Quincke, with more volume cost could be reduced as the the difference is the place of a hole. 

Ask for a Sprotte the next time you have an Lumbar puncture or Use one if you are performing one. Time to change Practise

CoI This is work from TeamG

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