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A comprehensive, bed-side scoring system to predict difficult lumbar puncture.

Shobha Subramanian1, B M Reshma1, M Salim Iqbal1

  • 1Department of Anesthesiology, Dr. B. R. Ambedkar Medical College and Hospital, Gandhi Nagar, Kadugondanahalli, Bengaluru, Karnataka, India.

Journal of Anaesthesiology, Clinical Pharmacology
|May 30, 2023
PubMed
Summary
This summary is machine-generated.

Predicting difficult lumbar puncture (LP) is crucial for spinal anesthesia (SA). A new scoring system effectively identifies patients likely to experience challenging LPs, enabling alternative anesthesia techniques.

Keywords:
Abdominal circumferencedifficult spinal lumbar puncturescoliometer smart appscoring systemspinal anesthesia

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Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Pain Management

Background:

  • Spinal anesthesia (SA) is a common neuraxial anesthesia technique.
  • Multiple lumbar puncture (LP) attempts can lead to patient discomfort and complications.
  • Predicting difficult LPs is essential for patient safety and procedural efficiency.

Purpose of the Study:

  • To evaluate patient variables that can predict difficult lumbar puncture (LP).
  • To develop a scoring system for assessing LP difficulty.
  • To facilitate the selection of alternative anesthetic techniques when difficult LP is anticipated.

Main Methods:

  • A study included 200 patients (ASA physical status I-II) undergoing elective infra-umbilical surgery under SA.
  • A preanesthetic difficulty score was calculated using five variables: age, abdominal circumference, spinal deformity (ATR), anatomical spine (SLGS), and patient position.
  • LP difficulty was graded by an independent investigator based on attempts and spinal levels.

Main Results:

  • Patient variables significantly correlated with difficult LP scoring (P < 0.001).
  • The Spinous Process Landmark Grading System (SLGS) was a strong predictor, while Axial Trunk Rotation (ATR) was a weak predictor.
  • A strong positive association (R = 0.6832, P < 0.00001) was found between the total difficulty score and LP difficulty grades. Median scores of 2, 5, and 8 predicted easy, moderate, and difficult LPs, respectively.

Conclusions:

  • The developed scoring system is a valuable tool for predicting difficult lumbar punctures.
  • This prediction aids anesthesiologists in choosing alternative anesthetic techniques, improving patient care.
  • Early identification of challenging LPs enhances procedural safety and patient outcomes.