Incidence of postdural puncture headache and backache following diagnostic/therapeutic lumbar puncture using a 22G cutting spinal needle, and after introduction of a 25G pencil point spinal needle

Background: Postdural puncture headache (PDPH) after lumbar puncture (LP) is as common in children as adults. 22G needles are routinely used in adults and children for diagnostic/therapeutic LP, in contrast to 25G or less as standard for spinal anesthesia. We sought to identify incidence of PDPH and backache in oncology children undergoing LP at Royal Marsden Hospital, and whether this could be reduced by a change from 22G to 25G pencil point needle. Methods: Symptom questionnaires were given to parents for completion 7 days following LP, and incidence of side effects ascertained. The standard needle was a 22G Quincke. A 25G pencil point spinal needle was subsequently introduced and incidence of side effects reaudited. Number of attempts with the pencil point needle was documented. Results: Fifty-six of 83 questionnaires were completed for the 22G Quincke (67%). Incidence of headache was 33%, with 11% classified as PDPH (6 children, 2 > 7 days). Nausea/vomiting occurred in 25% and backache in 11%; 43 of 79 questionnaires were completed for the 25G pencil point needle (54%). Incidence of headache was 30% with 7% classified as PDPH (3 children, none > 7 days). Nausea/vomiting occurred in 23%, and backache in none. Seventy percentage of needle insertions by pediatricians were successful on first attempt, 89% on second, and 100% on third. Conclusions: We have confirmed a significant incidence of PDPH in oncology patients and suggest that a 25G pencil point needle can be used successfully for diagnostic/therapeutic LP, with significantly reduced incidence of back pain, and a small tendency towards a shorter duration of PDPH symptoms.