Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: A randomised, observer-blind, controlled clinical trial [ISRCTN 71598245]

Purpose A common complication of lumbar puncture (LP) is postural headaches. Epidural blood patches are recommended if patients fail conservative management. Owing to a perceived increase in the number of post-lumbar puncture headaches (PLPHs) requiring epidural blood patches at a regional hospital in our network, the decision was made to switch from 20 to 22 gauge needles for routine diagnostic LPs. Materials and methods Patients presenting for LP and myelography at one network regional hospital were included in the study. The patients were contacted by nursing staff 3 days post-procedure; those patients who still had postural headaches after conservative management and received epidural blood patches were considered positive cases. In total, 292 patients were included; 134 underwent LP with 20-gauge needles (53 male, 81 female, average age 57.7) and 158 underwent LP with 22-gauge needles (79 male, 79 female, average age 54.6). Results Of 134 patients undergoing LP with 20-gauge needles, 15 (11%) had PLPH requiring epidural blood patch (11 female, 3 male, average age 38). Of 158 patients undergoing LP with 22-gauge needles, only 5 (3%) required epidural blood patches (all female, average age 43). The difference was statistically significant ( p < 0.01). Risk factors for PLPH included female gender, younger age, lower body mass index, history of prior PLPH and history of headaches. Conclusion Switching from 20-gauge to 22-gauge needles significantly decreased the incidence of PLPH requiring epidural blood patch. Narrower gauge or non-cutting needles should be considered in patients with risk factors for PLPH, allowing for CSF requirements.

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Low-pressure CSF shunt malfunction without preceding lumbar puncture treated by epidural blood patch: report of 2 cases

Child s Nervous System ◽

10.1007/s00381-020-04996-7 ◽

2021 ◽

Vol 37 (3) ◽

pp. 973-976

Author(s):

Adeline Kim ◽

Doyle Lim ◽

Joseph Piatt

Keyword(s):

Lumbar Puncture ◽

Epidural Blood Patch ◽

Low Pressure ◽

Shunt Malfunction ◽

Csf Shunt ◽

Blood Patch

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Position for Lumbar Punctures

PEDIATRICS ◽

10.1542/peds.89.5.976 ◽

1992 ◽

Vol 89 (5) ◽

pp. 976-976

Author(s):

JOAQUIM M.B. PINHEIRO

Keyword(s):

Clinical Trial ◽

Head And Neck ◽

Lumbar Puncture ◽

Local Anesthesia ◽

Controlled Clinical Trial ◽

Lateral Neck ◽

Physiologic Responses ◽

Fetal Position

To the Editor.— In "A Controlled Clinical Trial of Local Anesthesia for Lumbar Punctures in Newborns"1 Porter et al reported on their attempt to decrease lumbar puncture-induced physiologic instability by using lidocaine. While the cardiorespiratory measures of physiologic instability were not affected by local anesthesia, they were influenced significantly and adversely by the preparatory procedure (ie, being held flexed in the fetal position). As pointed out by the authors, the position chosen for the procedure, which included knees to chest plus flexion of head and neck has been shown to induce more adverse physiologic responses than either the sitting or the modified lateral (neck not flexed) position.2,3

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A Controlled Clinical Trial of Local Anesthesia for Lumbar Punctures in Newborns

PEDIATRICS ◽

10.1542/peds.88.4.663 ◽

1991 ◽

Vol 88 (4) ◽

pp. 663-669 ◽

Cited By ~ 1

Author(s):

Fran L. Porter ◽

J. Philip Miller ◽

F. Sessions Cole ◽

Richard E. Marshall

Keyword(s):

Carbon Dioxide ◽

Clinical Trial ◽

Heart Rate ◽

Lumbar Puncture ◽

Local Anesthesia ◽

Subcutaneous Administration ◽

Control Group ◽

Controlled Clinical Trial ◽

Transcutaneous Oxygen ◽

Experimental Group

To evaluate the efficacy of subcutaneous administration of lidocaine for reducing physiologic instability in acutely ill newborns during clinically required procedures, 81 neonates who required lumbar punctures within the first month of life were stratified by birth weight and respiratory support and randomly assigned to an experimental or a control group. The experimental group received an injection of 0.1 mL/kg of 1% lidocaine prior to the lumbar puncture. The control group received a nonanesthetized lumbar puncture without placebo. Changes in heart rate, respiratory rate, transcutaneous oxygen and carbon dioxide tensions, and heart rate variability from baseline, preparatory (positioning/handling), lumbar puncture, and recovery periods were measured. The administration of lidocaine did not minimize physiologic instability in response to the lumbar puncture nor was it associated with any detectable adverse effects other than prolonging the duration of the lumbar puncture. Although significant physiologic changes were observed in response to preparatory procedures, few additional changes beyond those occurred in response to lumbar punctures in either the experimental or control group. It is concluded that local anesthesia failed to influence manifestations of physiologic instability during neonatal lumbar punctures and that preparatory procedures were more destabilizing than either the administration of lidocaine or the lumbar puncture itself. The results suggest that the management of newborns requires emphasis on minimizing the destabilizing effects of required and frequent handling procedures.

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