Postdural puncture headache with cutting spinal needle vs pencil point spinal needle: Systematic review

Abstract

Introduction: Postdural puncture headache is one of the most frequent complications that occurs after the puncture of the dura mater, resulting in the spinal fluid leakage, through the same and subsequent traction of brain structures. Objective: To compare cutting spinal needle and pencil point spinal needle in the incidence of postural dural puncture headache. Materials and Methods: A literature search of scientific articles published since 2006 was carried out in the Pubmed, Science Direct, Clinical Key and EBSCO databases, which evaluates the incidence of postdural puncture headache in spinal needles with conical tip and cutting bevel, additionally, experts will be consulted in the area that should suggest literature related to this topic, which would not have been included in the search methods previously described. Results: In total, 14 studies were selected in the population that suffered puncture of the dura mater after accidental, therapeutic or diagnostic lumbar puncture (LP) and the presentation of postdural puncture headache was measured according to the ICHD-3 beta criteria. It was found that there is a decrease in the incidence of postdural puncture headache with conical tip spinal needles, compared to spinal needles of cutting bevel. Conclusions: Current evidence indicates that postdural puncture headache occurs less frequently, with low intensity and short duration in patients operated with a conical spinal needle, compared to the cutting bevel. In addition, according to the recently described pathophysiology, it is contradictory that conical spinal needles are called "atraumatic", so this review proposes a change in nomenclature that is most useful for the clinical anesthesiologist.