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04-04-2013 | Anaesthesiology | Article

Ultrasound enables fuss-free lumbar puncture


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medwireNews: Use of ultrasound imaging helps to minimize adjustments, failures, and trauma during lumbar puncture or epidural catheterization, conclude the authors of a systematic review and meta-analysis.

The analysis, which appears in BMJ, includes 1334 patients from 14 randomized controlled trials, of which five assessed lumbar punctures and nine studied epidural catheterizations. In an accompanying editorial, Paul Rizzoli (Brigham and Women's Faulkner Hospital, Boston, Massachusetts, USA) notes that the studies predominantly assessed "young women receiving obstetric anesthesia administered by highly experienced practitioners," which limits the generalizability of the findings.

"However, ultrasound guidance for lumbar puncture might offer even more benefits in non-obstetric populations," he says. "In these groups, lumbar puncture is more likely to be performed by practitioners with less procedural experience than obstetric anesthetists."

The analysis may therefore underestimate the potential benefits of routine use of ultrasound, he believes.

The overall risk for procedure failure was reduced by 79% with the use of ultrasound, giving a number needed to treat of 16 to prevent one failure. The effect of ultrasound imaging on risk reduction was similar for lumbar puncture (81%) and epidural catheterization (77%).

Ultrasound also reduced the risk for a traumatic procedure by 73%, with a number needed to treat of 17, and significantly reduced the number of needle insertion attempts and redirections by an average of 0.44 and 1.00 per procedure, respectively. The reduction in the number of needle insertion attempts was significantly larger for lumbar puncture than epidural catheterization, at respective average reductions of 1.01 and 0.23 per procedure.

"Because the baseline rate of failed procedures was low even when ultrasound was not used, it is unclear whether ultrasound imaging should be used for all lumbar punctures and epidural catheterisations," say lead researcher Furqan Shaikh (Hospital for Sick Children and University of Toronto, Ontario, Canada) and colleagues.

They suggest that "clinicians working in settings where these procedures are commonly performed (obstetric anaesthesia and emergency rooms) or where failure is associated with particularly negative consequences (paediatric oncology) should consider utilising ultrasound imaging."

By Eleanor McDermid, Senior medwireNews Reporter