The effect of introducing non-traumatic lumbar puncture needles in a Danish neurological department on the number of blood patches performed. A retrospective study

Background and Goal of Study: 
Postdural puncture headache (PDPH) is defined as a postural headache that occurs after a dural puncture. There are several risk factors for developing PDPH for example the design of needle tip. Severe PDPH is often treated with an epidural blood patch (EBP). It has previously been shown that the use of a non-traumatic needle reduces the risk of PDPH. However, recent studies have shown that the traumatic needle is still the first choice amongst Danish neurologists. 
The aim of the study was to investigate if the introduction of non-traumatic needles would reduce the incidence of EBP after dural punctures in a Danish neurologic department. 
Materials and methods: 
Before January 2013, almost all dural punctures were performed using a traumatic needle at our neurological department. From January 2013 to the end of September 2013, the neurologists were trained to use a non-traumatic needle. In October 2013, the non-traumatic needle was implemented as first choice when performing the procedure.
In the periods from January 2012 to the end of December 2012, (period A) and from October 2013 to the end of September 2014, (period B) the number of dural punctures and EBPs were registered retrospectively. The indication for using an EBP for treating PDPH was not revised over the same period.
Chi square analyses were used for the binary outcome data (blood patch and no blood patch) between the two groups (”traumatic” needle dural procedure and ”non-traumatic” needle dural procedure). A significance level of p=0.05 was used. 
Results and discussion: 
In period A and period B, 1335 respectively 1300 procedures were performed. The numbers of EBP in the two periods were 44 (3, 3%) and 18 (1, 4%). Chi square analyses were used for the binary outcome data (EBP and no EBP) between the two groups (traumatic or non-traumatic needle). A significance level of p=0,05 was used.
The difference in the number of the need of EBP in the two groups came out statistically significant (p = 0,002).
Conclusion(s):
The incidences of EBP were reduced by changing the needle type, from a 20G or 22G traumatic needle to a non-traumatic needle. This study underlines the importance of using a non-traumatic needle for dural puncture in order to reduce the risk of developing severe PDPH.

The effect of introducing non-traumatic lumbar puncture needles in a Danish neurological department on the number of blood patches performed. A retrospective study