According to a systematic review and meta-analysis, atraumatic lumbar puncture needles are safe and effective, and they cause fewer post-dural-puncture headaches and returns to the hospital for additional treatment. The findings reported in The Lancet.

Senior author Dr Saleh A. Almenawer said the study, based on a total of 110 trials including more than 30,000 patients showed that atraumatic needles decrease the risk of complications, including headaches and patient returning to the hospital for narcotics and blood patches, by more than 50%. The researchers conducted a systematic review and meta-analysis to compare patient outcomes after lumbar puncture with atraumatic needles versus conventional needles.

The researchers searched 13 databases for randomized controlled trials comparing the use of atraumatic needles and conventional needles for any lumbar puncture indication. The team excluded randomized trials in which no dural puncture was performed (epidural injections) and those without a conventional needle control group. The researchers analyzed data from 110 trials from 29 countries conducted between 1989 and 2017, including a total of 31,412 participants.

Postdural-puncture headache incidence dropped significantly from 11.0% in the conventional needle group to 4.2% in the atraumatic group. Atraumatic needles were also associated with significant decreases in the need for intravenous fluid or controlled analgesia; the need for epidural blood patch; any a headache, mild headache, severe headache; nerve root irritation; and hearing disturbance.

Lumbar puncture success on the first attempt, failure rate, average number of attempts, and incidence of traumatic tap and backache were similar with the two needle types. Subgroup analyses of a post-dural-puncture headache showed no interactions between needle type and patient sex, age, position, bed rest after the puncture, needle gauge, indication for lumbar puncture, use of intravenous fluid, or clinician speciality.

Atraumatic needles had fewer complications and the magnitude of the effect was larger than expected. This should change clinical practice and result in fewer patients with lumbar puncture complications. The frequency of post-lumbar puncture headache will decrease, and the number of hospital readmissions or epidural blood patches for the complication will be strongly reduced.

Atraumatic needles were invented >70 years ago, but, yet most clinicians (95% according to surveys) still use the conventional needles. Lumbar puncture is an extremely common procedure and the strong results from the study call for switching the type of needle. It is time to change the needle for the benefit of patients, Dr Almenawer said.