A Randomized Controlled Trial of Ultrasound-Assisted Lumbar Puncture

Nomura, Jason T.; Leech, Stephen; Shenbagamurthi, Srikala; Sierzenski, Paul; O’Connor, Robert E.; Bollinger, M.; Humphrey, Margaret; Gukhool, J.A.

doi:10.7863/jum.2007.26.10.1341

Cited by 116 publications

(95 citation statements)

References 27 publications

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“…The only similar study published to date, by Nomura et al, 20 came to a different conclusion than ours: that US showed a significant advantage over traditional landmark localization for the performance of LP. Although their success rate was similar to ours in the group of patients who did not receive US (73% vs. 78%), they had a significantly higher rate of success in their US group (96% vs. 76%).…”

Section: Discussioncontrasting

confidence: 81%

“…18,19 Only one other study we are aware of evaluated the benefits of using US for LP in a randomized controlled trial. 20 When evaluating the emergency department (ED) patient for possible subarachnoid hemorrhage (SAH), cerebral spinal fluid (CSF) analysis is often used to rule out SAH not seen on imaging studies. In these cases, if the emergency physician (EP) is unable to obtain CSF via LP, a specialist must be consulted to perform the procedure under imaging guidance.…”

mentioning

confidence: 99%

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Ultrasound for Routine Lumbar Puncture

Peterson

Pisupati

Heyming

et al. 2014

Academic Emergency Medicine

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Objectives: The objective was to determine if use of ultrasound (US) by emergency physicians (EPs) to localize spinal landmarks improves the performance of lumbar puncture (LP).Methods: This was a prospective, randomized, controlled study conducted in a county teaching hospital. Subjects, adults 18 years of age or older who were to receive LPs for routine clinical care in the emergency department (ED), were randomized either to undergo US localization of the puncture site or to have the puncture site determined by palpation of spinal landmarks. Primary outcomes were the number of needle insertion attempts and success of the procedure. Secondary outcomes were pain associated with the procedure, time to perform the procedure, number of traumatic taps, and patient satisfaction with the procedure.Results: One-hundred patients were enrolled in the study, with 50 in each study group. There were no significant differences between the two groups in terms of age, sex, body mass index (BMI), indication for LP, or ease of palpation of landmarks. For both primary outcomes and secondary outcomes there were no significant differences between those undergoing US localization and those with palpation alone.

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Section: Discussioncontrasting

confidence: 81%

mentioning

confidence: 99%

Ultrasound for Routine Lumbar Puncture

Peterson

Pisupati

Heyming

et al. 2014

Academic Emergency Medicine

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“…At least 20 randomized trials and 2 meta-analyses have since compared landmark-based vs ultrasound-guided techniques for lumbar puncture or epidural/spinal anesthesia. Key findings from these studies [9][10][11][12][13][14][15][16][17] are summarized in the table. A systematic review and meta-analysis of 14 randomized controlled trials evaluated whether ultrasound decreased the risk of failed LPs or epidural catheterizations compared to standard palpation of landmarks.…”

Section: Literature Reviewmentioning

confidence: 99%

“…22 LP spine mapping has generally shown the greatest benefit in patients with poorly palpable landmarks most commonly due to obesity. 10,18,21 Other predictors of difficult LP include abnormal spinal anatomy, such as scoliosis, previous spinal surgery, or history of difficult LP. Ultrasound was superior to a landmark-guided approach in patients with one or more of these predictors undergoing spinal anesthesia.…”

Section: Literature Reviewmentioning

confidence: 99%

Ultrasound guidance for lumbar puncture

et al. 2016

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Purpose of review: To review the literature and describe techniques to use ultrasound to guide performance of lumbar puncture (LP). Recent findings:Ultrasound evaluation of the lumbar spine has been shown in randomized trials to improve LP success rates while reducing the number of attempts and the number of traumatic taps. Summary: Ultrasound mapping of the lumbar spine reveals anatomical information that is not obtainable by physical examination, including depth of the ligamentum flavum, width of the interspinous spaces, and spinal bone abnormalities, including scoliosis. Using static ultrasound, the lumbar spine anatomy is visualized in transverse and longitudinal planes and the needle insertion site is marked. Using real-time ultrasound guidance, the needle tip is tracked in a paramedian plane as it traverses toward the ligamentum flavum. Future research should focus on efficient methods to train providers, costeffectiveness of ultrasound-guided LP, and the role of new needle-tracking technologies to facilitate the procedure. Neurol Clin Pract 2016;6:358-368 P oint-of-care ultrasound is being increasingly used to guide bedside procedures. For certain bedside procedures, such as central venous catheterization, use of ultrasound guidance is now considered the standard of care. For other procedures, such as lumbar puncture (LP), ultrasound can facilitate performance of the procedure by revealing underlying anatomy. Although many clinicians can perform LP based on landmarks with high success rates, an increasing body of evidence supports the use of ultrasound guidance, particularly in obese patients with less palpable landmarks. A recent study demonstrated a 19% failure rate of LPs performed in a neurology clinic when landmarks alone were used. A strong correlation between body mass index (BMI) and procedure failure was shown with half of the failed LPs in patients with a BMI .35.

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“…In the study mentioned earlier linking BMI with landmark identification, US guidance allowed their identification in all obese patients, 3 and others showed its benefit when performing LPs in different settings. [7][8][9] The added costs of fluoroscopy and US guidance over the standard procedure seem comparable. 10 The benefits, risks, and cost of stratifying morbidly obese patients to an initial USassisted LP in the clinic should be prospectively evaluated.…”

mentioning

confidence: 99%