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Lidocaine for lumbar punctures. A help not a hindrance
C Carraccio1, P Feinberg, L S Hart
1Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA.
Insights
Lidocaine premedication for pediatric lumbar puncture (LP) does not impede cerebrospinal fluid (CSF) collection. While some definitions showed more traumatic LPs with lidocaine, this was not clinically significant, supporting its use.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Anesthesiology
Background:
- Lumbar puncture (LP) is a common diagnostic procedure in pediatric emergency settings.
- The use of local anesthetics like lidocaine for premedication is debated regarding its effect on LP success and sample quality.
- Ensuring efficient and accurate cerebrospinal fluid (CSF) collection is crucial for timely diagnosis in children.
Purpose of the Study:
- To evaluate if lidocaine premedication affects the ease of CSF collection during pediatric LPs.
- To determine if lidocaine influences the rate of traumatic LPs, defined by red blood cell counts in the CSF.
- To provide evidence-based recommendations for pain management during pediatric LPs.
Main Methods:
- A randomized controlled trial was conducted in a pediatric emergency department.
- 100 children under 3 years requiring LP were randomized to receive either lidocaine or no local anesthetic.
- Outcomes measured included the number of attempts for CSF collection and the incidence of traumatic LPs.
Main Results:
- No significant difference was observed in the number of attempts required to obtain CSF between the lidocaine and no-anesthetic groups.
- Defining a traumatic LP by >1000 x 10(6)/L RBCs showed more traumatic LPs in the lidocaine group.
- However, using a definition of >10,000 x 10(6)/L RBCs revealed no significant difference in traumatic LPs, irrespective of lidocaine use.
Conclusions:
- Lidocaine premedication does not hinder the ease of CSF collection via lumbar puncture in young children.
- The increased incidence of traumatic LPs observed with lidocaine is of questionable clinical significance based on standard definitions.
- The study advocates for the use of local anesthetic premedication in pediatric LPs performed in emergency departments.
Objective:
To determine whether premedication for lumbar puncture (LP) with lidocaine hinders collection of cerebrospinal fluid (CSF) through either increased number of attempts or increased incidence of traumatic punctures.
Design:
A randomized controlled trial.
Setting:
The pediatric emergency department of an innercity teaching hospital.
Patients:
A convenience sample of 100 children, younger than 3 years, who required an LP as part of their diagnostic workup.
Intervention:
Patients were randomized to receive either lidocaine or no local anesthetic before undergoing an LP.
Main Outcome Measures:
Comparison of the number of attempts needed to obtain CSF and the number of traumatic LPs between the lidocaine-treated and no local anesthetic groups.
Results:
The 51 patients randomized to receive lidocaine did not differ markedly in age from the 49 patients randomized to receive no local anesthetic. Ease of obtaining CSF, as measured by number of attempts, did not differ with 59% of the patients in each group requiring 1 attempt. Defining a traumatic LP as more than 1000 x 10(6)/L red blood cells in the CSF showed notably more traumatic LPs in the lidocaine-treated group. Defining a traumatic LP as one with more than 10,000 x 10(6)/L red blood cells in the CSF showed no significant difference in the number of traumatic LPs whether or not the patient was premedicated with lidocaine. The level of experience of the physician performing the LP did not affect the outcome.
Conclusions:
Premedication with lidocaine for an LP does not binder the ease of obtaining CSF. The clinical relevance of a greater number of traumatic LPs in the lidocaine-treated group is questionable because this finding is negated when traumatic is defined as more than 10,000 x 10(6)/L CSF red blood cells. Based on these results, we advocate premedication with a local anesthetic when an LP is performed in the pediatric emergency department.
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