if you do get the lumbar puncture, show whoever's going to do it this site:
i think hopefully this stuff is pretty much common knowledge http://www.pulmonaryreviews.com/dec00/pr_dec00_puncturehead.html, but maybe i happened to be one of the ppl that are not helped by even the most careful angle of insertion. i only found all this out after the fact and never asked my neuro how he'd done my LP. but if it comes up for you, why not be sure it's all known, when someone's about to stick the needle into your own spinal cord!!
Anesthesiology. 1989 May;70(5):729-31.
Needle bevel direction and headache after inadvertent dural puncture.Norris MC, Leighton BL, DeSimone CA.
Department of Anesthesiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
To study the effect of needle bevel direction on the incidence and severity of headache following inadvertent dural puncture occurring during the identification of the epidural space, the authors randomly assigned obstetric anesthesia residents to identify epidural space with the bevel of the epidural needle oriented either parallel or perpendicular to the longitudinal dural fibers. If dural puncture occurred, an observer unaware of the needle bevel direction, daily assessed the presence and severity of any subsequent headache. Of the 1,558 women who received epidural analgesia during this study, 41 women suffered dural puncture, 20 with the needle bevel oriented perpendicular to the longitudinal dural fibers and 21 with the needle bevel inserted parallel to the dural fibers (NS). Fourteen of 20 women in the group in which the needle bevel was perpendicular to dural fibers developed a moderate to severe headache, whereas only five of 21 in the group in which the needle bevel was parallel to dural fibers did so (P less than 0.005). Similarly, we administered a therapeutic blood patch to ten of 20 women in the perpendicular group but to only four of 21 in the parallel group (P less than 0.05). Thus, identifying the epidural space with the needle bevel oriented parallel to the longitudinal dural fibers limits the size of the subsequent dural tear and, therefore, lowers the incidence of headache should dural perforation occur.
Volume 8 Issue 2 Page 75-78, June 1988
Post-lumbar-puncture headache: The significance of body posture. A controlled study of 300 patients
Steinar T Vilming, Harald Schrader, Inge Monstad (1988)
Post-lumbar-puncture headache: The significance of body posture
A controlled study of 300 patients
Steinar T Vilming, Harald Schrader, Inge MonstadDepartment of Neurology, Ullevål Hospital, University of Oslo, Oslo, Norway
Correspondence to Steinar T Vilming, Department of Neurology, Akershus County Hospital, 1474 Nordbyhagen, Norway;
In this single-blind, randomized study of post-lumbar-puncture headache (PPH) in 300 neurologic inpatients the significance of body posture after lumbar puncture (LP) was evaluated. Immediate mobilization was compared with bed rest for 6 h (3 h prone followed by 3 h supine posture). Contrary to the widely held belief, this investigation did not show significant differences between recumbent and ambulant patients as to frequency of PPH in the total material (39% versus 35%) or when men (31% versus 29%) and women (48% versus 41%) were evaluated separately. Headache associated with nausea was significantly more frequent in the recumbent than in the ambulant patients both in the total material (23% versus 13%) and in women (35% versus 16%). Thus, immediate mobilization seems to be preferable after LP.
Journal European Archives of Psychiatry and Clinical Neuroscience
Issue Volume 235, Number 2 / March, 1985
Is obligatory bed rest after lumbar puncture obsolete?
Marianne Dieterich1 and Th. Brandt1
Received: 14 March 1985
Summary After lumbar puncture (LP) an epidural CSF leakage caused by delayed closure of a dural defect leads to a decrease in CSF pressure. The resultant venous dilatation as well as downward shift of the brain with traction on pain-sensitive blood vessels and nerves frequently evokes post-lumbar puncture headache (PLPH), when the patient assumes the upright position. In previous studies differing opinions have been expressed about the prophylactic value of the posture taken by the patient after LP. The present study was designed to evaluate the benefit of the decrease of hydrostatic CSF pressure on the dural rent, when the patient lies down in a prone position with the head tilted down at an angle of 10° for 30 min immediately after LP: is it possible to accelerate the closure of the dural defect in this way and prevent PLPH? One group of patients (n = 78) lay in a prone position with the head tilted down at an angle of 10° for 30 min, the other group (n = 82) rose immediately after LP. PLPH was found to be independent of the posture in both groups and affected 44% and 41% of the patients, respectively, so that there is no longer any justification for requiring patients to remain in bed after LP.
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