Impact of spinal needle type on postdural puncture headache among women undergoing Cesarean section surgery under spinal anesthesia: A meta-analysis.
OBJECTIVE: Spinal anesthesia is the most frequently performed anesthesia for cesarean section. The American Society of Anesthesiology recommends using pencil-point spinal needles (SNs) over cutting-bevel SNs to reduce postdural puncture headache (PDPH) in their practice guidelines for obstetric anesthesia. However, there is no meta-analysis addressing the impact of the type of SNs on PDPH among women undergoing Cesarean section surgery.
METHODS: We conducted a systematic review and meta-analysis including randomized controlled trials comparing the incidence of PDPH of pencil-point SNs with cutting-bevel SNs in patients undergoing Cesarean section with spinal anesthesia. A comprehensive search of PubMed, Cochrane Library, EMBASE, and CINAHL without using any language and time restrictions were performed.
RESULTS: A total of 4936 patients from 20 studies (31 comparisons) were included. Pencil-point SN leads to reduced PDPH (risk ratio [RR] 0.33, 95% confidence intervals [CI] 0.25 to 0.45) and reduced requirement of epidural blood patch (RR = 0.21, 95% CI 0.09 to 0.51) compared to cutting-bevel SN. The incidence of anesthesia failure, non-PDPH, backache, and other adverse effects was not statistically significantly difference between the two SNs. Overall quality of evidence was moderate to low.
CONCLUSIONS: Using pencil-point SN appears to be beneficial for preventing PDPH in patients undergoing Cesarean section without increasing any potential adverse effects. Further research addressing the specific gauge of pencil-point SNs, which might further reduce the incidence of PDPH is highly desired.
Published In/Presented At
Lee, S. I., Sandhu, S., Djulbegovic, B., & Mhaskar, R. S. (2018). Impact of spinal needle type on postdural puncture headache among women undergoing Cesarean section surgery under spinal anesthesia: A meta-analysis. Journal of evidence-based medicine, 11(3), 136–144. https://doi.org/10.1111/jebm.12311
Medical Education | Medicine and Health Sciences
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