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Blood patch rates after lumbar puncture with Whitacre versus Quincke 22- and 20-gauge spinal needles. AJR Am J Roentgenol 2008 Jun;190(6):1686-9

Date

05/22/2008

Pubmed ID

18492925

DOI

10.2214/AJR.07.3351

Scopus ID

2-s2.0-44849119093 (requires institutional sign-in at Scopus site)   27 Citations

Abstract

OBJECTIVE: The objective of our study was to compare the incidence of blood patch as the best objective indicator of postdural puncture headache after elective fluoroscopic lumbar puncture with the use of a 22-gauge Whitacre (pencil point) needle versus standard 22- and 20-gauge Quincke (bevel-tip) needles and to determine the best level of puncture.

MATERIALS AND METHODS: The records of 724 consecutive patients who were referred to St. Mary's Medical Center department of radiology for fluoroscopic lumbar puncture from January 2003 through April 2007 were retrospectively reviewed. Emergency requests (191) were discarded along with those for patients with clinical signs of pseudotumor cerebri (21), normal pressure hydrocephalus (3), and failed attempts (4). The collective total was 505 elective lumbar punctures.

RESULTS: The blood patch rate for the 22-gauge Whitacre needle was 4.2%. The result for the 22-gauge Quincke point needle was 15.1% whereas that for the 20-gauge Quincke point needle was 29.6%. In addition, the level of puncture showed a blood patch rate that increased as the level of lumbar puncture lowered. The highest level of lumbar puncture was L1-L2 with the lowest recorded level being L5-S1.

CONCLUSION: The Whitacre needle is associated with a significantly lower incidence of blood patch rate after lumbar puncture. The highest level of puncture (L1-L2) also provides the lowest level of blood patch rate.

Author List

Hatfield MK, Handrich SJ, Willis JA, Beres RA, Zaleski GX

Author

Robert A. Beres MD Associate Professor in the Radiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Blood Patch, Epidural
Equipment Failure Analysis
Headache
Humans
Needles
Retrospective Studies
Spinal Puncture