want less post-LP headaches? re-insert the stylet

20 Dec

Best evidence topic report by Deibel et al. basically found one article worth its snuff:

Strupp et al:

  • 600 neurology patients getting LPs (21 gauge needle)
    • 300 to stylet replacement before needle removal
    • 300 not reinserted
  • followed-up for post-LP headache within 7 days
  • 49/300 (16%) post-LP headache when stylet NOT re-inserted
  • 15/300 (5%) when stylet reinserted.
  • Post-lumbar puncture syndrome was also less severe (2.8 v 4.5 scale of 10) if stylet reinserted

 

BOTTOM LINE:

Replacing the stylet before removal of the spinal needle may help decrease the incidence of post-lumbar puncture headaches

 

References: best evidence report; original article; picture

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