Atraumatic Needles Reduce Headache Incidence Following Lumbar Puncture

cerebrospinal fluid csf
cerebrospinal fluid csf
Investigators assessed the impact of atraumatic vs conventional needles on patient outcomes after lumbar puncture.

Atraumatic needles, which feature a blunt and closed pencil-point tip, reduce the risk of postdural-puncture headache as well as the need for additional medical therapy among patients undergoing lumbar puncture, according to findings from a systematic review and meta-analysis published in The Lancet.

Investigators identified 110 randomized controlled trials that compared atraumatic needles to conventional “traumatic” needles for patients undergoing lumbar puncture.  The primary outcome was the incidence of postdural-puncture headache, which was assessed by fulfillment of the International Classification of Headache Disorders III criteria. The investigators also compared efficacy and safety outcomes in both groups.

In the final analysis, 31,412 participants who underwent lumbar puncture were included. Significantly fewer patients experienced postdural-puncture headache in the atraumatic (4.2%; 95% CI, 3.3-5.2) vs conventional (11.0%; 95% CI, 9.1-13.3) needle groups, with participants in the atraumatic needle group experiencing a 60% lower risk than those randomly assigned to conventional needles (relative risk [RR] 0.40; 95% CI, 0.34-0.47; P <.0001).

Patients undergoing lumbar puncture with atraumatic needles also experienced greater reductions in intravenous fluid or controlled analgesia requirements compared with the use of conventional needles (RR 0.44; 95% CI, 0.29-0.64; P <.0001). Atraumatic needles were also associated with significantly lower requirements for epidural blood patch (RR 0.50; 95% CI, 0.33-0.75; P =.001), as well as fewer incidences of any headache (RR 0.50; 95% CI, 0.43-0.57; P <.0001), mild headache (RR 0.52; 95% CI, 0.38-0.70; P <.0001), severe headache (RR 0.41, 95% CI, 0.28-0.59; P <.0001), nerve root irritation (RR 0.71; 95% CI, 0.54-0.92; P =.011), and hearing disturbances ( RR 0.25; 95% CI, 0.11-0.60; P =.002).

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Future research may be necessary to determine whether the benefits of atraumatic needles extend to healthcare costs, an analysis that was lacking in this study. Also, considering this research was performed in a mostly adult population, the findings may not generalize to pediatric or elderly patients.

Findings from this meta-analysis provide both healthcare policy makers as well as clinicians with “a comprehensive assessment and high-quality evidence for the safety and efficacy of atraumatic needles as a superior option for patients who require lumbar puncture.”


Nath S, Koziarz A, Badhiwala JH, et al. Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis. Lancet. 2018;391(10126):1197-1204.