Abstract ID: A14

Abstract Title: Bevel Direction and Postdural Puncture Headache: a Meta-analysis

Poster Type: Either

ABSTRACT BODY

Introduction:
The effect of lumbar puncture needle bevel direction on the incidence of postdural puncture headache (PDPH) is controversial. We performed a meta-analysis of available trials to determine if bevel direction during lumbar puncture would influence the incidence of PDPH.
Materials and Methods:
Studies were identified primarily by searching the National Library of Medicine's PubMed database (1966- November 29, 2004) and abstracts from several national meetings (ASA, IARS, ASRA, SOAP) for terms related to needle and bevel direction. Inclusion criteria were assessment of the incidence of PDPH after lumbar puncture with a “cutting” needle (e.g., Quincke, Tuohy), comparison of a “parallel” (bevel oriented in a longitudinal or cephalad-to-caudad direction) to “perpendicular” (bevel oriented in a transverse direction) orientation during needle insertion, randomized trials, and trials primarily in adult populations. Data on study characteristics and incidence of PDPH were abstracted from qualified studies and subsequently analyzed.
Results:
The search resulted in 52 abstracts from which the original articles were obtained and data abstracted with ultimately a total of 5 articles meeting all inclusion criteria. Insertion of a cutting needle with the bevel oriented in a parallel/longitudinal fashion resulted in a significantly lower incidence of PDPH compared to that oriented in a perpendicular/transverse fashion (8.3% vs. 25%, OR = 0.26, 95% CI = 0.15-0.44).
Discussion:
Our meta-analysis indicates that with use of a cutting needle, insertion of in a parallel/longitudinal fashion may significantly reduce the incidence of PDPH although the reasons for this reduction are unclear.

ATTACHED FILES

Reg Anesth Pain Med 2004; 29(2):A14