Research in context
Evidence before this study
Several surveys show that clinicians' knowledge about the existence of atraumatic needles and their adoption in clinical practice is poor. More than 100 trials have compared atraumatic needles and conventional needles, but these trials were largely single-centre with a small sample size, which even if powered to detect the effect of needle tip design for the primary outcome of postdural-puncture headache, were not sufficiently powered to examine key additional outcomes. Moreover, previous trials were underpowered to detect interactions between needle tip design and important clinical subgroups. Previously published meta-analyses also failed to reach consensus on this topic because of methodological limitations.
Added value of this study
To the best of our knowledge, our systematic review and meta-analysis is the most broad and robust analysis comparing atraumatic and conventional needles to date. Our study was not only powered to detect a difference in the primary outcome of postdural-puncture headache, but also 11 additional outcomes. Moreover, evidence from this study was not limited to a single clinical discipline and was obtained from a large sample size (>30 000 participants), which enhanced generalisability and enabled the interaction between needle tip design and key predefined patient subgroups and procedural characteristics to be assessed. Prespecified subgroup analyses for the primary outcome revealed no interactions between needle type and patient and care delivery characteristics suggesting that our findings indicate a true effect of the atraumatic tip design.
Implications of all the available evidence
Evidence from this study suggests that atraumatic needles are associated with significant reductions in the risk of postdural-puncture headache and other complications, with similar efficacy to their conventional counterparts. Additionally, atraumatic needles reduced the need for patients to return to hospital for medical or invasive therapy. Our findings offer clinicians and health-care policy makers a comprehensive assessment and high-quality evidence for the safety and efficacy of atraumatic needles as a superior option for patients who require lumbar puncture.