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Headache after lumbar puncture: randomised crossover trial of 22-gauge versus 25-gauge needles
Catherine Crock1, Francesca Orsini, Katherine J Lee
1Royal Children's Hospital, , Melbourne, Australia.
Insights
This study found little difference in post-lumbar puncture headache rates between 22-gauge and 25-gauge needles in children undergoing leukemia treatment. Needle size did not significantly impact headache occurrence, though the 25-gauge needle was linked to longer procedure times.
Area of Science:
- Pediatric Oncology
- Neurology
- Medical Device Research
Background:
- Lumbar puncture (LP) is a common procedure in pediatric oncology.
- Post-LP headache is a frequent complication, impacting patient well-being and treatment adherence.
- Needle size is a potential factor influencing LP outcomes, including headache and procedure duration.
Purpose of the Study:
- To compare the incidence of post-LP headache and procedure time using 25-gauge versus 22-gauge needles in children.
- To evaluate secondary outcomes such as any headache occurrence and family impact.
Main Methods:
- A 4-period crossover blinded randomized controlled trial was conducted.
- The study involved 93 children aged 4-15 years undergoing LPs for leukemia treatment.
- Each child received LPs with both 22-gauge and 25-gauge needles in a randomized sequence.
Main Results:
- No significant difference was observed in post-LP headache rates between the 22-gauge (7.2%) and 25-gauge (4.6%) needles (p=0.3).
- Overall headache incidence also showed no significant difference (22-gauge: 18%, 25-gauge: 15%, p=0.4).
- The 25-gauge needle was associated with longer procedure times, and headaches were more common in girls.
Conclusions:
- The choice between 22-gauge and 25-gauge needles for pediatric LP shows minimal difference in headache occurrence.
- Procedure time may be longer with the 25-gauge needle.
- Needle gauge selection for pediatric LP should consider procedural circumstances and operator experience.
Objectives:
To compare the frequency of headache and the procedure time following lumbar puncture (LP) using a 25-gauge needle compared to a 22-gauge needle.
Design:
4-period crossover blinded randomised controlled trial.
Setting:
Oncology unit, Royal Children's Hospital, Melbourne.
Patients:
Children aged 4-15 years at enrolment having LPs as part of their treatment for leukaemia.
Interventions:
Each child was allocated a random sequence of four LPs, two with a 22-gauge and two with a 25-gauge needle.
Outcome Measures:
The presence of post-LP headache. Secondary outcomes included the presence of any headache, procedure time and impact of headache on the family.
Results:
Data on 341 procedures in 93 randomised children were analysed. There was little difference in the incidence of post-LP headache between the two needle sizes (22-gauge 7.2%, 95% CI 3.8 to 12.2; 25-gauge 4.6%, 95% CI 2.0 to 8.9, p=0.3) or in the incidence of any headache (22-gauge 18% 95% CI 12.5 to 24.6; 25-gauge 15%, 95% CI 10.0 to 21.1, p=0.4). Use of the 25-gauge needle was associated with longer procedure times. The incidence of post-LP headache showed little evidence of an age effect (OR =1.1, 95% CI 0.98 to 1.3) and was higher in girls than in boys (11% vs 3%, respectively, OR=3.3, 95% CI 1.3 to 8.4, p=0.014). Fifty-five per cent of families with a child with a post-LP headache assessed the overall functional impact as moderate or severe.
Conclusions:
There was little difference in the occurrence of post-LP headache or any headache between procedures carried out using the 22-gauge or 25-gauge needles. Depending on the circumstances of the procedure and the experience of the operator, either gauge may be appropriate for an LP in a child.
