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Local Anesthetics: Clinical Application as Spinal Anesthesia

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...

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Change practice now! Using atraumatic needles to prevent post lumbar puncture headache.

A Davis¹, R Dobson, S Kaninia

¹Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Barts Health NHS Trust, The Royal London Hospital, London, UK.

European Journal of Neurology

|December 11, 2013

Summary

Using atraumatic needles for diagnostic lumbar puncture (LP) significantly reduces post-LP headaches (PLPHA). Despite evidence, UK neurologists rarely use these needles due to lack of training and availability.

Keywords:

atraumatic needle needle design post lumbar puncture headache

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Area of Science:

Neurology
Medical Procedures

Background:

Lumbar puncture (LP) is a common diagnostic procedure.
Post-lumbar puncture headache (PLPHA) is a frequent complication.
Atraumatic needles for diagnostic LP (ATNLP) may reduce PLPHA risk.

Purpose of the Study:

Compare PLPHA occurrence between ATNLP and traumatic needles for diagnostic LP (TNLP).
Assess ATNLP usage among UK neurologists.
Evaluate the clinical and economic impact of ATNLP versus TNLP.

Main Methods:

Service development study comparing ATNLP and TNLP in 109 patients.
Blinded telephone assessments at 2 and 7 days post-LP.
Questionnaire survey of 74 UK neurologists on ATNLP familiarity and use.

Main Results:

ATNLP significantly reduced PLPHA rates (27.1% vs. 60.4%, P < 0.01).
PLPHA symptoms were shorter-lived and less severe with ATNLP.
Only 20% of UK neurologists regularly use ATNLP, citing training and availability issues.

Conclusions:

ATNLP is effective in reducing PLPHA incidence and severity.
Increased training is needed to promote ATNLP adoption among clinicians.