Needle Type Research Articles

Does needle size matter? Effects of micro-hypodermic needle injections of botulinum toxin type A in patients with hemifacial spasm

IntroductionBotulinum toxin type A (BoNT/A) injections are the first-line treatment for primary hemifacial spasms (HFS), but require frequent painful injections. Although micro-hypodermic needles are commonly used for aesthetic BoNT/A injections to lessen pain and bruising, their benefits in HFS remain unclear. ObjectiveTo compare side effects of BoNT/A injection, specifically pain and bruising, between primary HFS patients who received injections using micro-hypodermic needles (34-G) and those using standard needles (30-G). MethodsThis cross-over, double-blind, randomised controlled trial involved HFS patients who received BoNT/A injections using either a 34-G or 30-G needle at two visits 12 weeks apart. Primary outcomes, pain and bruising were assessed immediately after injection using the Visual Analogue Scale (VAS) and Short-form McGill Pain Questionnaire (Thai version, SF-MPQ). Bruise assessment was also conducted one week after each injection. Secondary outcomes involved comparing efficacy of BoNT/A between the two types of needles and assessing other complications beyond pain and bruising. Results65 HFS patients (47 women and 18 men; mean age 59.46 ± 11.48 years; mean disease duration 5.86 ± 4.16 years) were included in the study. Patients who received 34-G needle injections reported significantly reduced pain, as indicated by VAS, total SF-MPQ scores, and bruise scores, compared to those who received 30-G needle injections (p < 0.001, each). There were no differences in efficacy or occurrence of other complications associated with BoNT/A between the two needle types. ConclusionIn HFS patients, BoNT/A injections using micro-hypodermic needles resulted in reduced pain and bruising, compared to standard needles, while maintaining similar BoNT/A benefits.

Nominal logistic regression analysis of variables determining needle visibility in ultrasound images – a full factorial cadaver study

BackgroundNeedle visualization is essential to avoid vascular puncture and nerve injury in ultrasound-guided regional anesthesia. Several factors that statistically influence needle visibility have been described but the dimensions of their individual impact remain unclear. This study aimed to quantify the impact of various independent factors on ultrasound needle visibility.MethodsA total of 1500 ultrasound videos of in-plane needle insertions were obtained in embalmed cadavers with ten different commercially available echogenic and non-echogenic needles at different insertion angles and bevel orientations in a full factorial study design. The visibility of needle tip and shaft were rated as “good” or “poor” visibility. Nominal logistic regression analyses were calculated for the visibility of the needle tip and shaft.ResultsSonoPlex Stim Sprotte, SonoTAP Facet (needle tip and shaft) and Spinostar PencilPoint (needle tip)), insertion angle and bevel orientation were associated with good ultrasound visibility, reaching statistical significance (p < 0.05). The range of the effect on the log-odds scale for needle tip visibility was largest for the insertion angle with 6.33, followed by the tissue condition (3.76), bevel orientation (1.45) and the needle types (1.25). Regarding the needle shaft visibility, the largest effect range was observed with the insertion angle (7.36), followed by the tissue conditions with 3.96, needle type (1.86) and bevel orientation (0.95).ConclusionIn-plane needle visibility in ultrasound images depends mainly on the insertion angle, as expected. This is closely followed by the tissue condition, which is a factor related to the patient, thus cannot be altered to improve needle visibility. In the dimensions of the log-odds scale, the choice of a specific needle is far less important towards achieving a good visualization, whereas optimizing the bevel orientation can have a larger impact than the needle choice. Concluding from the relative dimensions of factors that determine needle visibility in this model, the importance of needles with echogenic features may be overrated.

Influence of needle type on epidural injection performance in cats

Influence of needle type on epidural injection performance in cats

Comparing the diagnostic adequacy of 25-Gauge fork-tip versus franseen versus reverse-bevel-type needles in EUS-guided tissue acquisition: A prospective randomized study with a retrospective control.

EUS-guided fine-needle biopsy (FNB) is an established technique for the acquisition of tissue to diagnose lesions of the gastrointestinal tract and surrounding organs. Recently, newer-generation FNB needles have been introduced, including a second-generation reverse-bevel and the third-generation fork-tip and Franseen needles. We aimed to determine if there was any difference between these needles in terms of cytopathological diagnostic yield, sample cellularity, or sample bloodiness. One hundred twenty-seven consecutive patients undergoing EUS-guided FNB of any solid lesion were randomized to use either a Franseen or fork-tip needle in a 1:1 ratio and were compared with 60 consecutive historical cases performed with reverse-bevel needles. Patient and procedure characteristics were recorded. Cases were reviewed by a blinded cytopathologist and graded based on cellularity and bloodiness. Overall diagnostic yield was calculated for each study arm. One hundred seventy-six cases were eligible for analysis, including 109 pancreatic masses, 24 lymphoid lesions, 17 subepithelial lesions, and 26 other lesions. The final diagnosis was malignancy in 127 cases (72%). EUS-guided FNB was diagnostic in 141 cases (80%) overall and in 89% of cases where malignancy was the final diagnosis. There was no difference in diagnostic yield, sample cellularity, or sample bloodiness between the different needle types. There was no difference in adverse events between groups. EUS-guided FNB performed using 25-gauge Franseen, fork-tip, and reverse-bevel needles resulted in similar diagnostic yield, sample cellularity, and sample bloodiness. Our results may not be extrapolated to larger-caliber needles of the same design.

Development of needle-thread integrative embedding needle

The needle-thread integrative embedding needle consists of needle handle, needle core, thread, locker and needle guard. The thread is fixed in the core by the locker. With the needle inserted into acupoint, the locker is separated from the thread, while the thread is embedded directly into acupoint, to achieve one acupoint with one needle. This type of thread embedding needle is operated simply and safely without cross infection occurrence, easy to carry.

Use of finer needles for venipuncture increases in vitro haemolysis despite reducing persistent pain and nerve injury: A retrospective study.

Although venipuncture is minimally invasive, and is the most frequently performed medical procedure, it carries the small risk of causing persistent pain, including nerve damage. Recently, our hospital stopped using 22-gauge needles for venipuncture in outpatients and switched to using only 23- and 25-gauge needles. We investigated the impact of using only the finer needles on the incidence of persistent or neuropathic pain and the prevalence of haemolysis, as well as the impact of haemolysis associated with the needle change on other laboratory data. We retrospectively collected and analysed data on venipuncture-associated pain complaints made during the 1-year period prior and 1-year period after the change in needles, as well as the frequency of haemolysis before and after the change. We also focused on 90 cases that showed significant haemolysis after the needle change and compared the serum aspartate aminotransferase, lactate dehydrogenase, and potassium levels before and after the needle change. The incidence of persistent pain was significantly reduced from 1 in 10,825 venipunctures before the change to 1 in 29,747 venipunctures after the change. Notably, no patients experienced neuropathic pain after the change. However, the prevalence of haemolysis was significantly increased. Additionally, the serum aspartate aminotransferase, lactate dehydrogenase, and potassium levels were significantly elevated in the cases that showed moderate to gross haemolysis after the needle change. Using finer needles involves both advantages and disadvantages, and careful consideration is needed to determine which type of needle is in the best interests of the patient.

Clinical Applications of Endobronchial Ultrasound (EBUS) Scope: Challenges and Opportunities.

Endobronchial Ultrasound (EBUS) has been widely used to stage lung tumors and to diagnose mediastinal diseases. In the last decade, this procedure has evolved in several technical aspects, with new tools available to optimize tissue sampling and to increase its diagnostic yield, like elastography, different types of needles and, most recently, miniforceps and cryobiopsy. Accordingly, the indications for the use of the EBUS scope into the airways to perform the Endobronchial Ultrasound-TransBronchial Needle Aspiration (EBUS-TBNA) has also extended beyond the endobronchial and thoracic boundaries to sample lesions from the liver, left adrenal gland and retroperitoneal lymph nodes via the gastroesophageal tract, performing the Endoscopic UltraSound with Bronchoscope-guided Fine Needle Aspiration (EUS-B-FNA). In this review, we summarize and critically discuss the main indication for the use of the EBUS scope, even the more uncommon, to underline its utility and versatility in clinical practice.

Comparison of suction techniques for EUS-guided tissue acquisition: Systematic review and network meta-analysis of randomized controlled trials.

Background and study aims Despite the widespread use of endoscopic ultrasound (EUS)-guided tissue acquisition, the choice of optimal suction technique remains a subject of debate. Multiple studies have shown conflicting results with respect to the four suction techniques: Dry suction (DS), no suction (NS), stylet slow-pull (SSP) and wet suction (WS). Thus, the present network meta-analysis (NMA) was conducted to compare the diagnostic yields of above suction techniques during EUS-guided tissue acquisition. Methods A comprehensive literature search from 2010 to March 2022 was done for randomized trials comparing the aspirated sample and diagnostic outcome with various suction techniques. Both pairwise and network meta-analyses were performed to analyze the outcomes: sample adequacy, moderate to high cellularity, gross bloodiness and diagnostic accuracy. Results A total of 16 studies (n=2048 patients) were included in the final NMA. WS was associated with a lower odd of gross bloodiness compared to DS (odds ratio 0.50, 95% confidence interval 0.24-0.97). There was no significant difference between the various suction methods with respect to sample adequacy, moderate to high cellularity and diagnostic accuracy. On meta-regression, to adjust for the effect of needle type, WS was comparable to DS in terms of bloodiness when adjusted for fine-needle aspiration needle. Surface under the cumulative ranking analysis ranked WS as the best modality for all the outcomes. Conclusions The present NMA did not show superiority of any specific suction technique for EUS-guided tissue sampling with regard to sample quality or diagnostic accuracy, with low confidence in estimates.

The Effectiveness of Student-Led Musculoskeletal and Vascular Ultrasound Workshops at a Single Institution: A Retrospective Survey Analysis.

Introduction Point-of-care ultrasound (POCUS) is a rapidly evolving field of diagnostic medicine as its low cost, portability, and versatility have made handheld ultrasound (US) probes an invaluable tool for many modern physicians. Despite US's benefits as a bedside evaluative tool, many medical schools have not integrated POCUS into their pre-clerkship medical education due to a lack of equipment and faculty. The first objective of our study was to determine whether student tutors (STs) would be effective resources to teach musculoskeletal (MSK) and vascular US to preclinical medical students. The second objective of our study was to determine whether students who previously attended ST-run MSK US workshops perform better in vascular US than those who did not. Methods Six POCUS workshops were led by STs after approval from experienced US faculty. These included US workshops on gastrointestinal structures, forearm structures, joint structures, basic echocardiography, and US-guided IV access. We collected data from two of our six workshops. We developed surveys to gauge the confidence and ability of students to perform US after an MSK workshop and US-guided IV access workshop led by STs. We also measured students' US abilities and collected student feedback after our US-guided IV access workshop.We evaluated students' US competency in US-guided IV access via their ability to correctly position the US probe, angle the needle of insertion, move the probe with the needle, and access the vein based on the accuracy of the movements. We divided student results into two groups: students who previously attended the MSK workshop before attending the US-guided IV access workshop and students who did not attend the MSK workshop before attending the US-guided IV access workshop. We used averages, frequencies, and two-tailed t-tests to analyze the survey responses and US-guided IV access skill assessments. Results Fifty percent of first- and second-year surveyed students "agreed," and 32.4% "strongly agreed" that they felt confident using US after an ST-run MSK workshop. About 29.4% of surveyed students "agreed" and 41.2% "strongly agreed" that they felt comfortable explaining basic US concepts, such as proper probe positioning and echogenicity. The group of students who attended the MSK workshop prior to the peripheral IV workshop scored similarly to the students who did not attend the MSK workshop (14.33±1.03 versus 14.20±0.84 points). Both groups of students had an average of over 94% accuracy in technique, positioning, angling, moving the US probe, and achieving US-guided venous access after being taught by STs. Qualitative surveying noted positive student feedback, such as "Teacher was great at guiding us through the procedure." Survey responses also included suggestions on adding and diversifying equipment, such as "[It would be useful to have a] different type of needle to see the difference on ultrasound." Conclusion Based on the high percentages of accuracy and confidence, we found that STs were effective resources to teach MSK and vascular POCUS and that students who attended previous MSK ST-run US workshops had stronger vascular US ability over time compared to those who did not. Our data supportthe use of STs as US educational resources, especially in institutions without an existing pre-clerkship US curriculum and limited US resources.

Conventional versus aspiration-type needles in CT-guided biopsy for chest pathologies/lesions: A comparative study.

Larger sample volume can be obtained in one needle pass using an aspiration-type semi-automatic cutting biopsy needle (STARCUT® aspiration-type needle; TSK Laboratory, Tochigi, Japan) in comparison to the conventional semi-automatic cutting biopsy needle. To evaluate and compare the safety and effectiveness of aspiration-type semi-automatic cutting biopsy needles and non-aspiration-type biopsy needles when performing computed tomography (CT)-guided core needle biopsies (CNBs). A total of 106 patients underwent CT-guided CNB for chest lesions between June 2013 and March 2020 at our hospital. Non-aspiration-type cutting biopsy needles were used in 47 of these patients, while aspiration-type needles were used in the remaining 59 patients. All needles used were 18- or 20-gauge biopsy needles. Parameters, like forced expiratory volume in 1-second percent (FEV1.0%), the maximum size of the target lesion, puncture pathway distance in the lung, number of needle passes, procedure time, diagnostic accuracy, and incidence of complications, were measured. Comparisons were made between the needle-type groups. No significant difference was observed in terms of diagnostic accuracy. However, the procedure time was shorter and a lesser number of needle passes were required with the aspiration-type cutting biopsy needle compared to the non-aspiration-type needle. Pneumothorax and pulmonary hemorrhage were the complications encountered, however, their incidence was not significantly different between the two types of needles. The aspiration-type semi-automatic cutting biopsy needle had similar diagnostic accuracy as the non-aspiration-type biopsy needle, with added advantages of a lesser number of needle passes and shorter procedure time.

Magnitude and associated factors of post Dural puncture headache after spinal anesthesia in surgical patients at comprehensive specialized referral hospital, 2021: A multi-center cross-sectional study

BackgroundPost-Dural Puncture Headache (PDPH) is a common problem that happens after the Dura-arachnoid puncture during the procedure for diagnosis, therapy, and spinal anesthesia administration. This study aimed to assess the magnitude and associated factors of post-dural puncture headache (PDPH) after spinal anesthesia in surgical patients. MethodA multi-center institution-based cross-sectional study was conducted from September 1 to November 30, 2021, on 402 patients who came for an operation under spinal anesthesia. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) window version 26. Data were collected using a structured questionnaire. Descriptive statistics were expressed in percentages and presented with tables and figures. Both Bivariable and multivariable logistic analyses were done to identify the magnitude and associated factors of post-Dural puncture headache (PDPH) after spinal anesthesia in surgical patients. P < 0.05 with 95 % CI was set as statistical significance. ResultThe magnitude of post-Dural puncture headache (PDPH) after spinal anesthesia in surgical patients was 39.2[95 % CI = (34.7–44.1)]. Multivariable logistic analyses showed that being female [AOR = 3.5;95 %CI = (1.89,6.47)], patents who are nonsmokers [AOR = 2.3; 95 %CI = (1.23, 4.39)], cutting type of needle [AOR = 2.8;95 %CI = (1.39,5.68)] cephalic needle direction [AOR = 7.4;95 %CI = (3.95,14)] number of attempts more than two[AOR = 6.9; 95 %CI = (6.65,13.3)] were factors significantly associated with post-Dural puncture headache. ConclusionThe magnitude of post-Dura puncture headache (PDPH) after spinal anesthesia in surgical patients in this study was high. This study showed that a small spinal needle was much better than a large cutting spinal needle in the frequency of post-dural puncture headaches. In addition, the events were associated with frequent attempts during lumbar puncture and increased cerebrospinal fluid leakage. We recommend the use of a small spinal needle; to avoid more leakage of cerebrospinal fluid and multiple attempts at spinal anesthesia and lumbar puncture.

OBSERVING CONDUCTANCE QUANTIZATION by a NOVEL MAGNETIC CONTROL SYSTEM

In this study, a novel magnetic system that allows observing quantized conductance for undergraduate and graduate laboratories is presented. Bending of a magnetic cylindrical beam, like a cantilever, was controlled by an electromagnet to provide contact between needle type electrode and a plane of conductor. It is shown that by using the beam bending, it is possible to displace an object on the beam in nanometer and micrometer scale. The measured quantized conductance results prove that the designed system can be used for demonstration of quantized conductance.

Etiology, management, and sequela of postdural puncture headache.

The purpose of this article is to provide readers with a concise overview of the cause, incidence, treatment of, and sequalae of postdural puncture headaches (PDPH). Over the past 2 years, much data has been published on modifiable risk factors for PDPH, treatments for PDPH, and sequalae of PDPH particularly long-term. There is emerging data about how modifiable risk factors for PDPH are not as absolute as once believed. There have been several new meta-analysis and clinical trials published, providing more data about effective therapies for PDPH. Significantly, much recent data has come out about the sequalae, particularly long-term of dural puncture. Emerging evidence demonstrates that in patients who are at low risk of PDPH, needle type and gauge may be of no consequence in a patient developing a PDPH. Although epidural blood patch (EBP) remains the gold-standard of therapy, several other interventions, both medical and procedural, show promise and may obviate the need for EBP in patients with mild-moderate PDPH. Patients who endure dural puncture, especially accidental dural puncture (ADP) are at low but significant risk of developing short term issues as well as chronic pain symptoms.

O-133 Follicular flushing increases the number of cumulus oocyte complexes retrieved. A Randomized Controlled Trial

Abstract Study question Does follicular flushing increase the number of cumulus oocyte complexes (COCs) retrieved compared to single aspiration? Summary answer Follicular flushing increases the number of COCs retrieved compared to single aspiration. What is known already On the basis of published meta-analyses, follicular flushing does not seem to increase the number of COCs retrieved and the probability of pregnancy. However, eligible RCTs in these meta-analyses are characterized by significant heterogeneity regarding the population studied, the needle type and lumen diameter, the aspiration pressure and the number of flushing attempts performed. Moreover, most of the studies do not offer information regarding the flow rate of the aspiration system used. A constant flow rate has been employed in a single RCT, in which a higher number of COCs was retrieved after follicular flushing compared with single aspiration. Study design, size, duration This is a single-center, randomized controlled trial, performed between July and December 2022. One hundred and five patients undergoing oocyte retrieval for intracytoplasmic sperm injection, aged &amp;lt;43 years, with BMI 18-35kg/m2 were included in the study. Random allocation of each ovary to flushing or single aspiration was performed by a study nurse on the day of oocyte retrieval, using a computer generated randomization list. Patients could enter the study only once. Participants/materials, setting, methods All follicles ≥11 mm were aspirated with the same double-lumen needle, using the same aspiration pressure (190 mmHg) to achieve a flow rate of 0.42 ml/sec. If no COC was found in the initial aspirate, flushing was performed in the corresponding group until a COC was retrieved, or up to a maximum of five times. The primary outcome measure was the number of COCs retrieved per ovary randomized. Values are expressed as median (interquartile range). Main results and the role of chance Significantly more COCs were retrieved per ovary randomized in the follicular flushing versus the single aspiration group, in all patients [5 (7) versus 2 (3), p &amp;lt; 0.001, respectively], in patients with high [9 (3) versus 5 (4), p &amp;lt; 0.001, respectively], normal [5 (2) versus 2 (3), p &amp;lt; 0.001, respectively] and low [1 (1) versus 1 (1), p &amp;lt; 0.001, respectively] ovarian response. No COCs were retrieved in 2.9% of the ovaries in the flushing group versus 16.2% of the ovaries in the single aspiration group (p &amp;lt; 0.001). The oocyte retrieval rate, which was defined as the ratio of COCs retrieved to the number of aspirated follicles ≥11 mm, was significantly higher in the follicular flushing versus the single aspiration group, in all patients [88.9% (25) versus 45.5% (37.5), p &amp;lt; 0.001, respectively], as well as in patients with high [81.8% (15.1) versus 45.5% (25.0), p &amp;lt; 0.001, respectively], normal [85.7% (28.6) versus 40% (30.0), p &amp;lt; 0.001, respectively], and low [100% (0) versus 50% (100), p &amp;lt; 0.001, respectively] ovarian response. No significant differences were observed regarding maturation rate, fertilization rate and the proportion of good quality embryos on day 2 in all patients as well as in patients with high, normal and low ovarian response. Limitations, reasons for caution The current study design, by randomizing ovaries instead of patients, eliminates heterogeneity attributed to multiple confounders and allows a more accurate evaluation of the true effect of follicular flushing on the number of COCs retrieved. However, it does not allow the detection of its effect on the probability of pregnancy. Wider implications of the findings This is the first RCT to show that follicular flushing increases the number of COCs retrieved compared to single aspiration, independently of ovarian response. The data presented suggests that follicular flushing plays an important role in increasing the efficacy of oocyte retrieval. Trial registration number NCT 05473455

Computational fluid dynamics in root canal irrigation.

Root canal irrigation is an important step in root canal preparation procedures and has a great impact on the success rate of root canal treatment. Computational fluid dynamics (CFD) is a new method to study root canal irrigation. It can be used to simulate and visualize the process of root canal irrigation, and quantitatively evaluate the effect of root canal irrigation through parameters such as flow velocity and wall shear stress. In recent years, researchers have conducted extensive studies on the factors that influence root canal irrigation efficiency, such as the position of the irrigation needle, the size of root canal preparation, the types of irrigation needles, and so on. This article reviewed the development of root canal irrigation research methods, the steps of CFD simulation in root canal irrigation, and the application of CFD in root canal irrigation in recent years. It aimed to provide new research ideas for the application of CFD to root canal irrigation and to provide a reference for the clinical application of CFD simulation results.

Clinical examination, ultrasound assessment and aspiration of knee effusion in primary knee osteoarthritis patients

BackgroundTo assess the diagnostic performance of clinical examination and ultrasound (US) assessment of knee effusion in primary knee osteoarthritis (KOA) patients. Furthermore, the success rate for effusion aspiration and the factors related to it were investigated.MethodsThis cross-sectional study included patients diagnosed with primary KOA-induced knee effusion clinically or sonographically. The affected knee of each patient was subjected to clinical examination and US assessment using the ZAGAZIG effusion and synovitis ultrasonographic score. Patients with confirmed effusion and consented to aspiration were prepared for direct US-guided aspiration under complete aseptic techniques.ResultsOne hundred and nine knees were examined. During visual inspection, swelling was detected in 80.7% of knees and effusion was confirmed by US in 67.8% of knees. Visual inspection was the most sensitive at 90.54% while bulge sign was the most specific at 65.71%. Only 48 patients (61 knees) consented to aspiration procedure; 47.5% had grade III effusion, and 45.9% had grade III synovitis. Successful aspiration was achieved in 77% of knees. Two needle types were used; a 22 gauge / 3.5-inch spinal needle in 44 knees and an 18 gauge/ 1.5-inch needle in 17 knees, with a success rate of 90.9% and 41.2%, respectively. Aspirated amount of synovial fluid correlated positively with effusion grade (rs=0.455, p < 0.001) and negatively with synovitis grade on US (rs = − 0.329, p = 0.01).ConclusionsThe superiority of the US over clinical examination in detecting knee effusion suggests that US should be used routinely to confirm the presence of effusion. Long needles (spinal needle) may have a higher success rate of aspiration than shorter needles.

Diagnostic Yield of Transabdominal Ultrasound-Guided Core Needle Method in Biopsies of Pancreatic Lesions.

In this study, it was aimed to contribute to the selection of the method to perform pancreatic lesion biopsies.Data of patients, who had undergone a percutaneous biopsy because of pancreatic masses in our institution in the period between January 2015 and November 2019, were evaluated retrospectively. The percutaneous biopsy method, the type of needle used in the procedure, and periprocedural complications were listed. Pathology and cytology reports in the archive were reviewed, and biopsy results were divided into 3 groups as benign, malignant, and inadequate. Of 308 patients included in the study, the diagnostic accuracy was verified in 124 patients through the assessment of surgical outcomes, results of biopsies from metastatic lesions, or follow-up findings. The verified results were classified as true-positives and true-negatives.Of a total of 308 patients included in the study, 23 underwent a fine-needle aspiration biopsy (FNAB) and 285 underwent a core needle biopsy (CNB). No statistical differences were observed in sample acquisition success and complications between the groups.Of the lesions with a confirmed pathological diagnosis, 67.74% were malignant and 32.26% were benign. The diagnosis was correct in 107 of 112 CNB patients (95.54%) and 9 of 12 FNAB patients (75.00%). When the success of the 2 methods was compared, it was found that outcomes of CNB were statistically more successful compared with those of FNAB.A transabdominal ultrasound-guided percutaneous CNB is a safe method with a high diagnostic yield to perform a biopsy of the pancreas.

Impact of spinal needle size and design on post-dural puncture headache: A narrative review of literature

Background: Post-dural puncture headache (PDPH) is a well-known iatrogenic complication of lumbar puncture. The main modifiable risk factors of PDPH appear to be needle size and design, which have been extensively modified in an effort to lower the incidence of PDPH. Currently, there is no consensus on the ideal needle tip for lumbar puncture. Therefore, we have conducted this narrative review of literature to provide a more definite answer regarding the impact of spinal needle size and design on PDPH. Methods: Relevant literature was obtained by searching the scientific literature using PubMed, EMBASE, ISI Web of Knowledge, and Google Scholar for from 1990 to July 2022. Results: Both size and design have been extensively researched in numerous randomized controlled trials. A total of seven systematic reviews published since 2016 were reviewed: Five combined with meta-analyses of which two also with a meta-regression analysis, one combined with a network meta-analysis, and one Cochrane review. Discussion and Conclusion: The evidence presented in this review consistently shows that the atraumatic design is less likely to cause PDPH than the traumatic design. There is no simple linear correlation between smaller needle size and lower incidence of PDPH in either needle type. In lumbar puncture for spinal anesthesia we advise the 26G atraumatic spinal needle as the preferred choice, as it is the least likely to cause PDPH and the most likely to enable successful insertion. If unavailable, the 27-gauge atraumatic needle is the next best choice.

Awareness of Postdural Puncture Headache Among Specialists who Perform Lumbar Punctures and/or Monitor Patients Following the Procedure.

Lumbar puncture (LP) is performed by specialists in different branches of medicine, complications may be encountered in various settings. In our study, we evaluated the awareness and knowledge of the diagnosis and treatment of post-dural puncture headache (PDPH) among specialists who performed LP and/or encountered complications. This was a prospective questionnaire/scale study of 253 physicians: LP performers (anaesthesiologists, Group A; others, Group B) and those who worked in departments that did not perform LP but frequently encountered complications following LP (Group C). The questionnaire assessed specialization, frequency of LPs utilization, needle types used, positions employed, awareness of LP complications, diagnosis, management, and risk factors for PDPH. Group A had the highest percentage of physicians who stated they had knowledge about PDPH (Group A: 96.4%, Group B: 77.3%, Group C: 39.4%; P=0.000). Group C was found to be statistically less informed than the other two groups (P=0.000). It was determined that only one (1%) physician from Group C correctly answered the question about the diagnostic criteria for PDPH. To our knowledge this is the first study in which the awareness of PDPH has been compared according to physicians' fields of specialisation. We believe that post-specialty training programs should be organized for physicians who will either perform LP or monitor patients who have undergone LP, and the curriculum content in relevant specialties should be reviewed.

Descriptions of sham acupuncture in randomised controlled trials: a critical review of the literature

BackgroundSham acupuncture is usually used to assess the specific effects of acupuncture. However, the reporting quality of sham acupuncture remains unclear despite its critical importance in understanding and analyzing the effects of acupuncture. This paper presents a literature review aimed at assessing the quality of reporting of sham acupuncture in randomized controlled trials (RCTs) based on STRICTA 2010 and TIDieR-Placebo.MethodsThree electronic English-language databases (PubMed, MEDLINE and Embase) were searched from inception to March 7, 2022, and RCTs of sham acupuncture were identified. The reporting quality of sham acupuncture was assessed in accordance with the items recommended in STRICTA 2010 and TIDieR-Placebo. The reporting quality of other items related to sham acupuncture apart from items from these two checklists was also captured to further assess the reporting quality of sham acupuncture.ResultsA total of 609 eligible studies were included. For all of the items recommended in STRICTA 2010 and TIDieR-Placebo, 100% of the studies reported a brief name that described the sham acupuncture, 93.9% studies reported the needle type, and 90.0% reported the names of the points used. Other items for which the reporting rates were above 50% included the number, frequency and duration of treatment sessions; needle retention time; and number of needle insertions per subject per session. Overall, 49.4% of the studies revealed the rationale why sham acupuncture was chosen, 39.7% of the studies involving insertion processes reported the depth of insertion, and 37.9% of the studies reported the needle manufacturer. Other items for which the reporting rates were below 30% included practitioner-related information, response sought, evaluation of blinding, intervention mode and environment, assisting tools, and the extent to which the treatment was varied. The items “Modifications”, “How well (planned)” and “How well (actual)” were not reported in any of the analyzed studies.ConclusionsThe overall reporting quality of sham acupuncture in RCTs was suboptimal. Although STRICTA 2010 and TIDieR-Placebo could be beneficial for describing sham acupuncture, neither can offer recommendations specifically for sham acupuncture. There is thus an urgent need to develop specialized guidelines for reporting sham acupuncture in clinical trials.