Reduction in Epidural Blood Patch Requirement after Switching from 22G Quincke to 26G Atraumatic Needles for Lumbar Puncture in Adults: A 4-Year Single-Centre Experience

Objective: Post-dural puncture headache (PDPH) is the most common complication of lumbar puncture (LP), and severe cases may require an epidural blood patch (EBP).Smaller-gauge atraumatic needles reduce PDPH, yet cutting needles remain in routine neurological use.We assessed whether a change in LP needle made by a single operator was associated with a lower requirement for EBP in adults.Method: We conducted a retrospective, single-centre, before-and-after study of consecutive LPs performed in adult (≥18 years) patients by a single neurologist over a 4-year period.A 22-gauge Quincke cutting needle was used in the first period and a 26-gauge atraumatic (Atraucan) needle in the second.The primary outcome was the proportion of patients requiring EBP.A procedure-level rate and a pre-specified sensitivity analysis were also reported.Groups were compared with the Fisher exact test.Results: Fifty-nine patients (24 in Period 1 and 35 in Period 2) underwent 97 procedures (27 and 70, respectively).Patient-level EBP was 25.0% (6/24) versus 2.9% (1/35) (odds ratio 11.3, 95% confidence interval 1.3-101.5;p=0.015).Procedure-level rates were 22.2% (6/27) versus 1.4% (1/70) (p=0.002).The sensitivity analysis yielded 28.0% (7/25) versus 2.9% (p=0.007).Conclusion: A change from a 22-gauge Quincke to a 26-gauge atraumatic needle by a single operator was associated with a lower EBP requirement.Given the retrospective before-and-after design and the small number of events, this association should not be interpreted as causal; nevertheless, the findings are consistent with existing evidence supporting small-gauge atraumatic needles for diagnostic and therapeutic LP.