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Real-time Ultrasound-guided Lumbar Puncture: A Comparison of Two Techniques Using Simulation.

Kara Samsel1, David Wasiak2, Elaine Situ-LaCasse2

  • 1Texas Tech University Health Sciences Center, Department of Emergency Medicine, El Paso, Texas.

The Western Journal of Emergency Medicine
|June 25, 2025
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Summary

Emergency physicians can be trained in ultrasound-guided lumbar puncture (LP) using either the paramedian sagittal oblique (PSO) or transverse interlaminar (TL) technique. Both methods show high success rates, but the PSO approach may be preferred for its perceived ease of use.

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Area of Science:

  • Emergency Medicine
  • Medical Simulation
  • Ultrasound Applications

Background:

  • Literature on real-time ultrasound-guided lumbar puncture (LP) is limited.
  • Two primary techniques exist: paramedian sagittal oblique (PSO) and transverse interlaminar (TL).
  • Emergency physicians' ability to perform ultrasound-guided LPs requires further assessment.

Purpose of the Study:

  • To compare procedure outcomes between the PSO and TL ultrasound-guided LP techniques.
  • To evaluate emergency physicians' proficiency in performing ultrasound-guided LPs.
  • To assess the feasibility of training emergency physicians in these techniques.

Main Methods:

  • Prospective study involving emergency physicians randomized into PSO (Group P) or TL (Group T) groups.
  • Participants received didactic training before performing ultrasound-guided LPs on a manikin.
  • Procedure data and post-procedure survey responses were collected.

Main Results:

  • High success rate (90.3%) for ultrasound-guided LP, with no significant difference between PSO and TL groups (15/16 vs 13/15).
  • The TL technique required a longer average procedure time (311.2s vs 176.7s, P=0.04).
  • Group T reported higher overall perceived difficulty compared to Group P (P=0.01).

Conclusions:

  • Emergency physicians can be effectively trained in ultrasound-guided LP using simulation.
  • Both PSO and TL techniques demonstrate high success rates in a simulated environment.
  • The PSO approach may be preferred over the TL technique due to perceived lower difficulty.