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LETTERS TO THE EDITOR

Encourage the Use of Noncutting Needles for Diagnostic Lumbar Punctures

North Valley Hospital, Whitefish, MT, Dr. Tsen does not wish to reply.

To the Editor:

I read with interest the article by Loughrey et al. (1) concerning spinal anesthesia after an epidural blood patch. Perhaps the use of 22-gauge cutting needles to perform diagnostic lumbar punctures (LPs) is another problem. Recently, I was surprised to learn that the nonanesthesiologist physicians doing diagnostic LPs at our hospital were not aware of the existence of noncutting needles and routinely used the 22-gauge Quinke needle supplied in the diagnostic LP kit. Although it takes a little longer to obtain the required amount of CSF using a smaller pencil-point needle, it will obviously result in a less frequent incidence of postdural puncture headache (PDPH) compared with the use of a 22-gauge cutting needle. We have updated our physicians on the advantages of noncutting needles and taped 24-gauge Sprotte needles to the top of our diagnostic LP kits. I would encourage anesthesiologists at other institutions where large cutting needles are used for diagnostic LPs to institute similar steps to reduce the incidence of PDPH after diagnostic LP.

Reference

1. Loughrey J, Eappen S, Tsen L. Spinal anesthesia for cesarean delivery shortly after an epidural blood patch. Anesth Analg 2003; 96: 545–7.[Abstract/Free Full Text]

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