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Optimal management after paediatric lumbar puncture: a randomized controlled trial

Bing Hu1, Tian-Ming Chen1, Bing Liu1

  • 1Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, Nalishi Road 56#, Xicheng District, Beijing, 100045, China.

BMC Neurology
|April 17, 2019
PubMed

Insights

A shorter 0.5-hour rest period after lumbar puncture (LP) is safe for children. This reduced fasting and lying time (LSFSL) did not increase the risk of post-lumbar puncture headache (PLPH) or back pain (PLPBP).

Area of Science:

  • Pediatric Medicine
  • Neurology
  • Clinical Trials

Background:

  • Lumbar puncture (LP) is a common procedure in pediatric patients.
  • Standard post-procedure care includes prolonged periods of lying supine and fasting (LSFSL).
  • The optimal duration of LSFSL to minimize risks like post-lumbar puncture headache (PLPH) and post-lumbar puncture lower back pain (PLPBP) is debated.

Purpose of the Study:

  • To determine if a shorter duration of lying supine without a pillow and fasting (LSFSL) after lumbar puncture (LP) increases the risk of PLPH and PLPBP in pediatric patients.
  • To compare the incidence of PLPH and PLPBP between a 0.5-hour LSFSL group and a 4-hour LSFSL group.

Main Methods:

  • A randomized, assessor-blinded, controlled trial involving 400 pediatric patients undergoing their first LP.
  • Patients were randomized into two groups: 0.5-hour LSFSL or 4-hour LSFSL.
  • Outcomes including PLPH, PLPBP, vomiting, vital signs, and other adverse events were measured. Non-inferiority and Wilcoxon rank-sum tests were used for analysis.

Main Results:

  • No significant difference in PLPH incidence between the groups (5.97% in 0.5-h LSFSL vs. 6.53% in 4-h LSFSL).
  • No significant difference in PLPBP incidence between the groups (6.97% in 0.5-h LSFSL vs. 8.54% in 4-h LSFSL).
  • No significant differences in vital signs or other adverse events were observed between the groups.

Conclusions:

  • A 0.5-hour LSFSL period after LP is not associated with a higher risk of PLPH, PLPBP, or other adverse events compared to 4 hours.
  • 0.5-hour LSFSL is sufficient for children undergoing lumbar puncture, potentially improving patient comfort and resource utilization.
Abstract

Keywords:
Duration of bed restLumbar puncturePostoperative complicationsSupine position

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