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dc.contributor.author
Arevalo-Rodriguez, Ingrid
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Muñoz, Luis
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Godoy-Casasbuenas, Natalia
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Ciapponi, Agustín
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Arevalo, Jimmy J.
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Boogaard, Sabine
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Roquéi Figuls, Marta
dc.date.available
2018-08-31T21:40:36Z
dc.date.issued
2017-04
dc.identifier.citation
Arevalo-Rodriguez, Ingrid; Muñoz, Luis; Godoy-Casasbuenas, Natalia; Ciapponi, Agustín; Arevalo, Jimmy J.; et al.; Needle gauge and tip designs for preventing post-dural puncture headache (PDPH); John Wiley & Sons Ltd; Cochrane Database of Systematic Reviews; 2017; 4; 4-2017; 1-218
dc.identifier.issn
1469-493X
dc.identifier.uri
http://hdl.handle.net/11336/58029
dc.description.abstract
Background: Post-dural puncture headache (PDPH) is one of the most common complications of diagnostic and therapeutic lumbar punctures. PDPH is defined as any headache occurring after a lumbar puncture that worsens within 15 minutes of sitting or standing and is relieved within 15 minutes of the patient lying down. Researchers have suggested many types of interventions to help prevent PDPH. It has been suggested that aspects such as needle tip and gauge can be modified to decrease the incidence of PDPH. Objectives: To assess the effects of needle tip design (traumatic versus atraumatic) and diameter (gauge) on the prevention of PDPH in participants who have undergone dural puncture for diagnostic or therapeutic causes. Search methods: We searched CENTRAL, MEDLINE, Embase, CINAHL and LILACS, as well as trial registries via the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal in September 2016. We adopted the MEDLINE strategy for searching the other databases. The search terms we used were a combination of thesaurus-based and free-text terms for both interventions (lumbar puncture in neurological, anaesthesia or myelography settings) and headache. Selection criteria: We included randomized controlled trials (RCTs) conducted in any clinical/research setting where dural puncture had been used in participants of all ages and both genders, which compared different tip designs or diameters for prevention of PDPH Data collection and analysis: We used the standard methodological procedures expected by Cochrane. Main results: We included 70 studies in the review; 66 studies with 17,067 participants were included in the quantitative analysis. An additional 18 studies are awaiting classification and 12 are ongoing. Fifteen of the 18 studies awaiting classification mainly correspond to congress summaries published before 2010, in which the available information does not allow the complete evaluation of all their risks of bias and characteristics. Our main outcome was prevention of PDPH, but we also assessed the onset of severe PDPH, headache in general and adverse events. The quality of evidence was moderate for most of the outcomes mainly due to risk of bias issues. For the analysis, we undertook three main comparisons: 1) traumatic needles versus atraumatic needles; 2) larger gauge traumatic needles versus smaller gauge traumatic needles; and 3) larger gauge atraumatic needles versus smaller gauge atraumatic needles. For each main comparison, if data were available, we performed a subgroup analysis evaluating lumbar puncture indication, age and posture. For the first comparison, the use of traumatic needles showed a higher risk of onset of PDPH compared to atraumatic needles (36 studies, 9378 participants, risk ratio (RR) 2.14, 95% confidence interval (CI) 1.72 to 2.67, I2 = 9%). In the second comparison of traumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH, with the exception of one study comparing 26 and 27 gauge needles (one study, 658 participants, RR 6.47, 95% CI 2.55 to 16.43). In the third comparison of atraumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH. We observed no significant difference in the risk of paraesthesia, backache, severe PDPH and any headache between traumatic and atraumatic needles. Sensitivity analyses of PDPH results between traumatic and atraumatic needles omitting high risk of bias studies showed similar results regarding the benefit of atraumatic needles in the prevention of PDPH (three studies, RR 2.78, 95% CI 1.26 to 6.15; I2 = 51%). Authors' conclusions: There is moderate-quality evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache. The studies did not report very clearly on aspects related to randomization, such as random sequence generation and allocation concealment, making it difficult to interpret the risk of bias in the included studies. The moderate quality of the evidence for traumatic versus atraumatic needles suggests that further research is likely to have an important impact on our confidence in the estimate of effect.
dc.format
application/pdf
dc.language.iso
eng
dc.publisher
John Wiley & Sons Ltd
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dc.rights
info:eu-repo/semantics/openAccess
dc.rights.uri
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.subject
Nnedle Gauge
dc.subject
Post-Dural Headache (Pdph)
dc.subject.classification
Salud Ocupacional
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dc.subject.classification
Ciencias de la Salud
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dc.subject.classification
CIENCIAS MÉDICAS Y DE LA SALUD
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dc.title
Needle gauge and tip designs for preventing post-dural puncture headache (PDPH)
dc.type
info:eu-repo/semantics/article
dc.type
info:ar-repo/semantics/artículo
dc.type
info:eu-repo/semantics/publishedVersion
dc.date.updated
2018-08-27T17:59:19Z
dc.journal.volume
2017
dc.journal.number
4
dc.journal.pagination
1-218
dc.journal.pais
Reino Unido
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dc.journal.ciudad
LOndres
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Fil: Arevalo-Rodriguez, Ingrid. Fundación Universitaria de Ciencias de la Salud; Colombia. Universidad Tecnologica Equinoccial; Ecuador
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Fil: Muñoz, Luis. Hospital de San Jose; Colombia
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Fil: Godoy-Casasbuenas, Natalia. Hospital de San Jose; Colombia
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Fil: Ciapponi, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
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Fil: Arevalo, Jimmy J.. VU University Medical Center; Países Bajos
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Fil: Boogaard, Sabine. VU University Medical Center; Países Bajos
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Fil: Roquéi Figuls, Marta. Iberamerican Cochrane Centre; España
dc.journal.title
Cochrane Database of Systematic Reviews
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dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/url/https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010807.pub2/full
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/doi/http://dx.doi.org/10.1002/14651858.CD010807.pub2
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