Lumbar puncture: reinsertion of the stylet decreased post-lumbar puncture syndrome.

Clinical bottom line (level 1b)

  1. Patients undergoing a lumbar puncture where the stylet is reinserted before the needle is removed were less likely to suffer post-lumbar puncture syndrome, than those where there is no reinsertion (NNT = 9 at 7 days) .
Strupp and Brandt: New England Journal of Medicine 1997; : 1190-1190
Expires January 2003

The study

?blinded ?concealed randomised trial ?with intention-to-treat
Setting: general hospital, Germany

600 patients (aged ?, ?% male) requiring lumbar puncture
Control Group: (n = 300, 300 analysed): no reinsertion
Experimental Group: (n = 300, 300 analysed): reinsertion of the stylet to the tip of the needle
A 21 gauge Sprotte atraumatic needle was used.
100% followed for 7 days
Outcome notes:
  • post-lumbar puncture syndrome : headache, tinnitus, dizziness or nausea

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
post-lumbar puncture syndrome 7 days 49
(16.3%)		 15
(5.00%)		 69.0%
(47.0% to 82.0%)		 11.3%
(6.48% to 16.2%)		 9
(6 to 15)

Comments

  1. Symptoms were only recorded if they were reproduced by a change in position and improved when the patient lay flat.

Citation

  1. Strupp M, and Brandt T: Should one reinsert the stylet during lumbar puncture?. New England Journal of Medicine 1997; : 1190-1190
Contributor: Clare Wotton & Bob Phillips, January 2000
Reviewer:

Clinical Question.
Patient requiring lumbar puncture
Intervention or Exposure reinsertion of the stylet
Comparison no reinsertion
Outcome post-lumbar puncture syndrome