To the Editor.
—The letter to the editor by Morrow et al1 describing their failure to prevent post-lumbar puncture headache (PLPHA) utilizing the oblique approach to lumbar puncture (LP) is well deserving of criticism. It is the experience in the anesthesia literature that the incidence of PLPHA is directly proportional to the gauge of the needle used as well as the number of attempts necessary to puncture the dura.2 In their letter, they did not address the caliber of needle used, and utilized "adequately trained residents and interns."Utilizing a 22-gauge needle, the incidence of PLPHA ranges between 2% and 9%,2 the greater incidence found among females, and decreasing in incidence with age. This incidence is significantly less than the 36% described by Morrow and coworkers. Utilizing a 25-gauge needle, the incidence of PLPHA is decreased even further when compared with the 22-gauge needle. Without reporting the needle gauge, the reported incidence of PLPHA is without meaning.
Klein DS. Post-Lumbar Puncture Cephalgia. Arch Neurol. 1988;45(12):1298. doi:10.1001/archneur.1988.00520360016001
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