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Respuestas clínicas Cochrane

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Study flow diagram
Figuras y tablas -
Figure 1

Study flow diagram

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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Forest plot of comparison: 1 Traumatic needle versus atraumatic needle, outcome: 1.1 PDPH by indication.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Traumatic needle versus atraumatic needle, outcome: 1.1 PDPH by indication.

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Funnel plot of comparison: 1 Traumatic needle versus atraumatic needle, outcome: 1.1 PDPH by indication.
Figuras y tablas -
Figure 5

Funnel plot of comparison: 1 Traumatic needle versus atraumatic needle, outcome: 1.1 PDPH by indication.

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Funnel plot of comparison: 3 Atraumatic needles: different gauges, outcome: 3.1 PDPH major gauge versus minor gauge by number.
Figuras y tablas -
Figure 6

Funnel plot of comparison: 3 Atraumatic needles: different gauges, outcome: 3.1 PDPH major gauge versus minor gauge by number.

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Comparison 1 Traumatic needle versus atraumatic needle, Outcome 1 PDPH by indication.
Figuras y tablas -
Analysis 1.1

Comparison 1 Traumatic needle versus atraumatic needle, Outcome 1 PDPH by indication.

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Comparison 1 Traumatic needle versus atraumatic needle, Outcome 2 PDPH by gauge.
Figuras y tablas -
Analysis 1.2

Comparison 1 Traumatic needle versus atraumatic needle, Outcome 2 PDPH by gauge.

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Comparison 1 Traumatic needle versus atraumatic needle, Outcome 3 PDPH by gender.
Figuras y tablas -
Analysis 1.3

Comparison 1 Traumatic needle versus atraumatic needle, Outcome 3 PDPH by gender.

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Comparison 1 Traumatic needle versus atraumatic needle, Outcome 4 PDPH/anaesthesia: type of surgery.
Figuras y tablas -
Analysis 1.4

Comparison 1 Traumatic needle versus atraumatic needle, Outcome 4 PDPH/anaesthesia: type of surgery.

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Comparison 1 Traumatic needle versus atraumatic needle, Outcome 5 PDPH by position.
Figuras y tablas -
Analysis 1.5

Comparison 1 Traumatic needle versus atraumatic needle, Outcome 5 PDPH by position.

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Comparison 1 Traumatic needle versus atraumatic needle, Outcome 6 PDPH by age.
Figuras y tablas -
Analysis 1.6

Comparison 1 Traumatic needle versus atraumatic needle, Outcome 6 PDPH by age.

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Comparison 1 Traumatic needle versus atraumatic needle, Outcome 7 AE: paraesthesia.
Figuras y tablas -
Analysis 1.7

Comparison 1 Traumatic needle versus atraumatic needle, Outcome 7 AE: paraesthesia.

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Comparison 1 Traumatic needle versus atraumatic needle, Outcome 8 AE: backache.
Figuras y tablas -
Analysis 1.8

Comparison 1 Traumatic needle versus atraumatic needle, Outcome 8 AE: backache.

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Comparison 1 Traumatic needle versus atraumatic needle, Outcome 9 Severe PDPH by indication.
Figuras y tablas -
Analysis 1.9

Comparison 1 Traumatic needle versus atraumatic needle, Outcome 9 Severe PDPH by indication.

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Comparison 1 Traumatic needle versus atraumatic needle, Outcome 10 Any headache by indication.
Figuras y tablas -
Analysis 1.10

Comparison 1 Traumatic needle versus atraumatic needle, Outcome 10 Any headache by indication.

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Comparison 1 Traumatic needle versus atraumatic needle, Outcome 11 PDPH sensitivity analysis.
Figuras y tablas -
Analysis 1.11

Comparison 1 Traumatic needle versus atraumatic needle, Outcome 11 PDPH sensitivity analysis.

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Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 1 PDPH larger gauge vs smaller gauge.
Figuras y tablas -
Analysis 2.1

Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 1 PDPH larger gauge vs smaller gauge.

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Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 2 PDPH by type of surgery.
Figuras y tablas -
Analysis 2.2

Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 2 PDPH by type of surgery.

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Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 3 PDPH by age.
Figuras y tablas -
Analysis 2.3

Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 3 PDPH by age.

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Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 4 PDPH by position.
Figuras y tablas -
Analysis 2.4

Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 4 PDPH by position.

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Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 5 AE: backache.
Figuras y tablas -
Analysis 2.5

Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 5 AE: backache.

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Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 6 Severe PDPH by gauge.
Figuras y tablas -
Analysis 2.6

Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 6 Severe PDPH by gauge.

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Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 7 Any headache.
Figuras y tablas -
Analysis 2.7

Comparison 2 Larger gauge traumatic needles versus smaller gauge traumatic needles, Outcome 7 Any headache.

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Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 1 PDPH larger gauge vs smaller gauge.
Figuras y tablas -
Analysis 3.1

Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 1 PDPH larger gauge vs smaller gauge.

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Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 2 PDPH by type of surgery.
Figuras y tablas -
Analysis 3.2

Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 2 PDPH by type of surgery.

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Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 3 PDPH by gender.
Figuras y tablas -
Analysis 3.3

Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 3 PDPH by gender.

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Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 4 PDPH by position.
Figuras y tablas -
Analysis 3.4

Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 4 PDPH by position.

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Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 5 AE: paraesthesia.
Figuras y tablas -
Analysis 3.5

Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 5 AE: paraesthesia.

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Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 6 AE: backache.
Figuras y tablas -
Analysis 3.6

Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 6 AE: backache.

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Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 7 Severe PDPH by gauge.
Figuras y tablas -
Analysis 3.7

Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 7 Severe PDPH by gauge.

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Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 8 Any headache by gauge.
Figuras y tablas -
Analysis 3.8

Comparison 3 Larger gauge atraumatic needles versus smaller gauge atraumatic needles, Outcome 8 Any headache by gauge.

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Summary of findings for the main comparison. Traumatic needles compared to atraumatic needles for prevention of post‐dural puncture headache (PDPH)

Traumatic needles compared to atraumatic needles for prevention of PDPH

Patient or population: patients undergoing lumbar punctures
Settings: all settings (countries: Argentina, Austria, Brazil, Canada, Denmark, Finland, France, Germany, India, Israel, Italy, Korea, Mexico, Nepal, Netherlands, Nigeria, Norway, Pakistan, Spain, Thailand, UK and USA)
Intervention: traumatic needles (Quincke, Greene, Hingson Ferguson, Lutz, Brace, Rovenstine, Lemmon)
Comparison: atraumatic needles (Whitacre, Atraucan, Sprotte, Cappe‐Deutsh, Pajunk, Gertie Marx, Durasafe, Cappe, Deutsch and Eldor)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Atraumatic needles

Traumatic needles

Onset of PDPH

30 per 1000

64 per 1000
(52 to 80)

RR 2.14
(1.72 to 2.67)

9378
(36 studies)

⊕⊕⊕⊝
moderate1

—

Adverse events: paraesthesia

52 per 1000

50 per 1000
(25 to 102)

RR 0.96
(0.47 to 1.96)

573
(3 studies)

⊕⊕⊕⊝
moderate1

—

Adverse events: backache

155 per 1000

147 per 1000
(118 to 183)

RR 0.94
(0.78 to 1.13)

3027
(12 studies)

⊕⊕⊕⊝
moderate1

—

Severe PDPH

0 per 1000

10 per 1000

RD 0
(0.00 to 0.01)

6420
(24 studies)

⊕⊕⊝⊝
low1,2

—

Any headache

221 per 1000

290 per 1000
(228 to 367)

RR 1.35
(1.17 to 1.57)

4104
(18 studies)

⊕⊕⊕⊝
moderate1

—

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PDPH: post‐dural puncture headache; RD: risk difference; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Risk of bias downgraded by one level due to unclear reporting (especially related to allocation concealment and random sequence generation issues).
2Inconsistency downgraded by one level due to presence of considerable heterogeneity (I2 = 42%), caused by one study focused on diagnostic lumbar punctures (Muller 1994).

Figuras y tablas -
Summary of findings for the main comparison. Traumatic needles compared to atraumatic needles for prevention of post‐dural puncture headache (PDPH)
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Summary of findings 2. Larger traumatic needles compared to smaller traumatic needles for prevention of post‐dural puncture headache (PDPH)

Traumatic needle(major gauge) compared to traumatic needle (minor gauge) for prevention of PDPH

Patient or population: patients undergoing lumbar punctures with traumatic needles (Quincke, Greene, Hingson Ferguson, Lutz, Brace, Rovenstine, Lemmon)
Settings: all settings (countries: Finland, Germany, India, Italy, Korea, Pakistan and USA)
Intervention: traumatic needle ‐ larger gauge (Quincke, Greene, Hingson Ferguson, Lutz, Brace, Rovenstine, Lemmon)
Comparison: traumatic needle ‐ smaller gauge (Quincke, Greene, Hingson Ferguson, Lutz, Brace, Rovenstine, Lemmon)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Traumatic needle ‐ smaller gauge

Traumatic needle ‐ larger gauge

Onset of PDPH

—

—

RR ranged

from 0.86 to 6.47

2288
(10 studies)

⊕⊕⊝⊝
low1,3

We decided against overall pooling of results because the gauge of a needle could be considered small in one comparison but large in another.

Adverse events: paraesthesia ‐ not reported

See comment

See comment

Not estimable

—

See comment

We did not identify any studies reporting this outcome.

Adverse event: backache

—

—

RR ranged
from 0.81 to 2.00

948
(3 studies)

⊕⊕⊕⊝
moderate1

We decided against overall pooling of results because the gauge of a needle could be considered small in one comparison but large in another.

Severe PDPH

—

—

RD ranged
from 0.00 to 0.00

1128
(6 studies)

⊕⊕⊝⊝
low1,2

We decided against overall pooling of results because the gauge of a needle could be considered small in one comparison but large in another.

Any headache

—

—

RR ranged
from 0.75 to 1.56

771
(3 studies)

⊕⊕⊕⊝
moderate1

We decided against overall pooling of results because the gauge of a needle could be considered small in one comparison but large in another.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PDPH: post‐dural puncture headache; RD: risk difference; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Risk of bias downgraded by one level due to unclear reporting (especially related to allocation concealment and random sequence generation issues).

2Imprecision downgraded by one level due to few events reported in each arm.

3Imprecision downgraded by one level due unclear clinical decisions indicated by each confidence interval limit.

Figuras y tablas -
Summary of findings 2. Larger traumatic needles compared to smaller traumatic needles for prevention of post‐dural puncture headache (PDPH)
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Summary of findings 3. Larger atraumatic needles compared to smaller atraumatic needles for prevention of post‐dural puncture headache (PDPH)

Atraumatic needle (major gauge) compared to atraumatic needle (minor gauge) for prevention of PDPH

Patient or population: patients undergoing lumbar punctures with atraumatic needles (Whitacre, Atraucan, Sprotte, Cappe‐Deutsh, Pajunk, Gertie Marx, Durasafe, Cappe, Deutsch and Eldor)
Settings: all settings (countries: Canada, France, India, Italy, Spain, UK and USA)
Intervention: atraumatic needle ‐ larger gauge (Whitacre, Atraucan, Sprotte, Cappe‐Deutsh, Pajunk, Gertie Marx, Durasafe, Cappe, Deutsch and Eldor)
Comparison: atraumatic needle ‐ smaller gauge (Whitacre, Atraucan, Sprotte, Cappe‐Deutsh, Pajunk, Gertie Marx, Durasafe, Cappe, Deutsch and Eldor)

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Atraumatic needle ‐ smaller gauge

Atraumatic needle ‐ larger gauge

Onset of PDPH

—

—

RR ranged from 0.38 to 9.3

3134
(13 studies)

⊕⊕⊝⊝
low1,2

We decided against overall pooling of results because the gauge of a needle could be considered small in one comparison but large in other.

Adverse events: paraesthesia

—

—

RR ranged from 1.03 to 7.61

439
(2 studies)

⊕⊕⊕⊝
moderate1

We decided against overall pooling of results because the gauge of a needle could be considered small in one comparison but large in other.

Adverse events: backache

—

—

RR ranged
from 0.95 to 5.00

526
(4 studies)

⊕⊕⊕⊝
moderate1

We decided against overall pooling of results because the gauge of a needle could be considered small in one comparison but large in other.

Severe PDPH

—

—

RD ranged
from 0 to 0.01

1983
(8 studies)

⊕⊕⊝⊝
low1,2

We decided against overall pooling of results because the gauge of a needle could be considered small in one comparison but large in other.

Any headache

—

—

RR ranged
from 1.13 to 2.17

1791
(7 studies)

⊕⊕⊕⊝
moderate1

We decided against overall pooling of results because the gauge of a needle could be considered small in one comparison but large in other.

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; PDPH: post‐dural puncture headache; RD: risk difference; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Risk of bias downgraded by one level due to unclear reporting (especially related to allocation concealment and random sequence generation issues).
2Imprecision downgraded by one level due unclear clinical decisions indicated by each confidence interval limit.

Figuras y tablas -
Summary of findings 3. Larger atraumatic needles compared to smaller atraumatic needles for prevention of post‐dural puncture headache (PDPH)
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Comparison 1. Traumatic needle versus atraumatic needle

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PDPH by indication Show forest plot

36

9378

Risk Ratio (M‐H, Random, 95% CI)

2.14 [1.72, 2.67]

1.1 Anaesthesia only

30

8401

Risk Ratio (M‐H, Random, 95% CI)

2.21 [1.60, 3.04]

1.2 Myelography only

3

548

Risk Ratio (M‐H, Random, 95% CI)

2.01 [1.34, 3.00]

1.3 Diagnostic lumbar puncture only

3

429

Risk Ratio (M‐H, Random, 95% CI)

2.22 [1.38, 3.58]

2 PDPH by gauge Show forest plot

20

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 22 gauge

5

877

Risk Ratio (M‐H, Random, 95% CI)

2.15 [1.56, 2.97]

2.2 25 gauge

5

1260

Risk Ratio (M‐H, Random, 95% CI)

2.48 [1.56, 3.95]

2.3 27 gauge

11

4076

Risk Ratio (M‐H, Random, 95% CI)

2.87 [1.81, 4.53]

3 PDPH by gender Show forest plot

9

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Only women

9

1424

Risk Ratio (M‐H, Random, 95% CI)

2.60 [1.62, 4.17]

4 PDPH/anaesthesia: type of surgery Show forest plot

30

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Caesarean section

8

1324

Risk Ratio (M‐H, Random, 95% CI)

3.12 [1.60, 6.10]

4.2 Orthopaedic procedures

3

994

Risk Ratio (M‐H, Random, 95% CI)

1.35 [0.58, 3.19]

4.3 Other surgeries

19

6083

Risk Ratio (M‐H, Random, 95% CI)

2.30 [1.50, 3.51]

5 PDPH by position Show forest plot

20

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 Lateral position

9

3242

Risk Ratio (M‐H, Random, 95% CI)

4.70 [2.39, 9.24]

5.2 Sitting position

11

2193

Risk Ratio (M‐H, Random, 95% CI)

2.11 [1.52, 2.94]

6 PDPH by age Show forest plot

36

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

6.1 No distinctions by age

34

9063

Risk Ratio (M‐H, Random, 95% CI)

2.17 [1.73, 2.73]

6.2 Only < 18 years

2

315

Risk Ratio (M‐H, Random, 95% CI)

1.69 [0.56, 5.12]

7 AE: paraesthesia Show forest plot

3

573

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.47, 1.96]

8 AE: backache Show forest plot

12

3027

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.78, 1.13]

9 Severe PDPH by indication Show forest plot

24

6420

Risk Ratio (M‐H, Random, 95% CI)

1.88 [1.20, 2.94]

9.1 Anesthesia

19

5542

Risk Ratio (M‐H, Random, 95% CI)

1.77 [0.88, 3.53]

9.2 Myelography

4

778

Risk Ratio (M‐H, Random, 95% CI)

1.70 [0.68, 4.28]

9.3 Diagnostic lumbar puncture

1

100

Risk Ratio (M‐H, Random, 95% CI)

3.0 [1.18, 7.63]

10 Any headache by indication Show forest plot

18

4104

Risk Ratio (M‐H, Random, 95% CI)

1.35 [1.17, 1.57]

10.1 Anaesthesia

16

3656

Risk Ratio (M‐H, Random, 95% CI)

1.38 [1.17, 1.63]

10.2 Myelography

2

448

Risk Ratio (M‐H, Random, 95% CI)

1.34 [0.81, 2.21]

11 PDPH sensitivity analysis Show forest plot

3

802

Risk Ratio (M‐H, Random, 95% CI)

2.78 [1.26, 6.15]
Figuras y tablas -
Comparison 1. Traumatic needle versus atraumatic needle
Ir a la tabla de la revisión
Comparison 2. Larger gauge traumatic needles versus smaller gauge traumatic needles

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PDPH larger gauge vs smaller gauge Show forest plot

10

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 23 G vs 25 G

1

53

Risk Ratio (M‐H, Random, 95% CI)

2.08 [0.20, 21.55]

1.2 25 G vs 27 G

4

1041

Risk Ratio (M‐H, Random, 95% CI)

1.82 [0.98, 3.39]

1.3 25 G vs 29 G

3

376

Risk Ratio (M‐H, Random, 95% CI)

2.13 [0.46, 9.78]

1.4 26 G vs 27 G

1

658

Risk Ratio (M‐H, Random, 95% CI)

6.47 [2.55, 16.43]

1.5 21 G vs 25 G

1

160

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.30, 2.44]

2 PDPH by type of surgery Show forest plot

10

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Caesarean section

2

455

Risk Ratio (M‐H, Random, 95% CI)

1.28 [0.64, 2.57]

2.2 Orthopaedic surgeries

2

213

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.38, 2.58]

2.3 Other surgeries

6

1620

Risk Ratio (M‐H, Random, 95% CI)

2.94 [1.23, 7.03]

3 PDPH by age Show forest plot

10

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 No distinctions about age

8

2175

Risk Ratio (M‐H, Random, 95% CI)

2.09 [1.11, 3.95]

3.2 Only children

1

60

Risk Ratio (M‐H, Random, 95% CI)

3.0 [0.13, 70.83]

3.3 Only > 60 years

1

53

Risk Ratio (M‐H, Random, 95% CI)

2.08 [0.20, 21.55]

4 PDPH by position Show forest plot

7

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Lateral position

5

859

Risk Ratio (M‐H, Random, 95% CI)

1.76 [0.98, 3.16]

4.2 Sitting position

2

584

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.64, 1.56]

5 AE: backache Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

6 Severe PDPH by gauge Show forest plot

6

Risk Difference (M‐H, Random, 95% CI)

Subtotals only

6.1 23 G vs 25 G

1

53

Risk Difference (M‐H, Random, 95% CI)

0.0 [‐0.07, 0.07]

6.2 25 G vs 27 G

3

815

Risk Difference (M‐H, Random, 95% CI)

0.00 [‐0.01, 0.01]

6.3 25 G vs 29 G

1

100

Risk Difference (M‐H, Random, 95% CI)

0.0 [‐0.04, 0.04]

6.4 21 G vs 25 G

1

160

Risk Difference (M‐H, Random, 95% CI)

0.0 [‐0.02, 0.02]

7 Any headache Show forest plot

3

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only
Figuras y tablas -
Comparison 2. Larger gauge traumatic needles versus smaller gauge traumatic needles
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Comparison 3. Larger gauge atraumatic needles versus smaller gauge atraumatic needles

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 PDPH larger gauge vs smaller gauge Show forest plot

13

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 22 G vs 24 G

1

375

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.20, 4.81]

1.2 22 G vs 25 G

2

334

Risk Ratio (M‐H, Random, 95% CI)

3.00 [0.32, 28.50]

1.3 24 G vs 25 G

2

647

Risk Ratio (M‐H, Random, 95% CI)

5.62 [1.00, 31.67]

1.4 25 G vs 26 G

3

519

Risk Ratio (M‐H, Random, 95% CI)

0.76 [0.30, 1.90]

1.5 25 G vs 27 G

2

612

Risk Ratio (M‐H, Random, 95% CI)

3.72 [0.59, 23.64]

1.6 26 G vs 27 G

2

258

Risk Ratio (M‐H, Random, 95% CI)

1.79 [0.30, 10.73]

1.7 27 G vs 29 G

1

389

Risk Ratio (M‐H, Random, 95% CI)

1.59 [0.58, 4.37]

2 PDPH by type of surgery Show forest plot

13

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Caesarean section

6

1263

Risk Ratio (M‐H, Random, 95% CI)

1.92 [0.64, 5.79]

2.2 Orthopaedic procedures

2

392

Risk Ratio (M‐H, Random, 95% CI)

1.24 [0.30, 5.07]

2.3 Other surgeries

5

1479

Risk Ratio (M‐H, Random, 95% CI)

1.44 [0.73, 2.83]

3 PDPH by gender Show forest plot

8

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Only women

8

1853

Risk Ratio (M‐H, Random, 95% CI)

1.06 [0.51, 2.20]

4 PDPH by position Show forest plot

10

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Sitting position

5

1106

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.45, 2.06]

4.2 Lateral position

5

992

Risk Ratio (M‐H, Random, 95% CI)

1.88 [0.65, 5.41]

5 AE: paraesthesia Show forest plot

2

439

Risk Ratio (M‐H, Random, 95% CI)

2.19 [0.31, 15.30]

6 AE: backache Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

7 Severe PDPH by gauge Show forest plot

8

Risk Difference (M‐H, Random, 95% CI)

Subtotals only

7.1 22 G vs 24 G

1

375

Risk Difference (M‐H, Random, 95% CI)

0.0 [‐0.01, 0.01]

7.2 22 G vs 25 G

1

234

Risk Difference (M‐H, Random, 95% CI)

0.0 [‐0.02, 0.02]

7.3 24 G vs 25 G

1

304

Risk Difference (M‐H, Random, 95% CI)

0.01 [‐0.02, 0.03]

7.4 25 G vs 26 G

2

311

Risk Difference (M‐H, Random, 95% CI)

0.01 [‐0.01, 0.03]

7.5 25 G vs 27 G

1

212

Risk Difference (M‐H, Random, 95% CI)

0.01 [‐0.02, 0.04]

7.6 26 G vs 27 G

1

158

Risk Difference (M‐H, Random, 95% CI)

0.0 [‐0.02, 0.02]

7.7 27 G vs 29 G

1

389

Risk Difference (M‐H, Random, 95% CI)

0.0 [‐0.01, 0.01]

8 Any headache by gauge Show forest plot

7

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

8.1 22 G vs 25 G

1

234

Risk Ratio (M‐H, Random, 95% CI)

2.17 [0.85, 5.51]

8.2 24 G vs 25 G

2

645

Risk Ratio (M‐H, Random, 95% CI)

1.17 [0.49, 2.77]

8.3 25 G vs 26 G

2

311

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.65, 1.99]

8.4 25 G vs 27 G

1

212

Risk Ratio (M‐H, Random, 95% CI)

1.87 [0.65, 5.39]

8.5 27 G vs 29 G

1

389

Risk Ratio (M‐H, Random, 95% CI)

1.80 [0.85, 3.83]
Figuras y tablas -
Comparison 3. Larger gauge atraumatic needles versus smaller gauge atraumatic needles
Ir a la tabla de la revisión