Comparing Ultrasonography and Surface Landmark-Guided Lumbar Puncture in Patients with Obesity and Difficult Anatomy; a Randomized Controlled Trial
学术急诊医学档案,
卷 11 编号 1 (2023),
15 十一月 2022
,
第 e59 页
https://doi.org/10.22037/aaem.v11i1.2026
摘要
Introduction: Previous studies have shown higher lumbar puncture (LP) success rates when using ultrasound guidance. This study aimed to compare the first-attempt success rate of ultrasound-guided LP with blind technique of needle insertion using the palpable spinal surface landmark in patients with obesity or a difficult anatomy.
Methods: This prospective randomized controlled study was performed at the emergency department of Ramathibodi Hospital, an academic tertiary university hospital, from August 2015 to July 2016.
Results: 40 patients were enrolled (20 surface landmark-guided and 20 ultrasound-guided LPs). 52.5% of the patients were male with the mean age of 60.33 ± 4.24 years. The first-attempt success rate in the ultrasound-guided LP group was significantly higher than the landmark-guided LP group (80% vs. 35%, respectively), with risk difference (RD) of 45.00% (95% confidence interval (CI): 17.72%, 72.28%). This indicated absolute risk reduction and number needed to treat of 45.00% and 2.22, respectively. The median procedural duration required to achieve successful LP in the ultrasound-guided LP group was significantly shorter than the surface landmark-guided LP group (5 [IQR: 3–18] minutes vs. 13.5 [IQR: 5-30] minutes, respectively). Traumatic puncture as a complication occurred less frequently in the ultrasound-guided LP group than the surface landmark-guided LP group with risk ratio (RR) = 0.33 (95% CI: 0.08, 1.46) and RD = -20.00% (95% CI: -44.00%, 4.00%). This indicated absolute risk reduction and number needed to harm of 20.00% and 5.00, respectively. However, the difference was not significant.
Conclusion: Using ultrasound to help localize the insertion point before LP increased the first-attempt success rate and improved other LP outcomes in Thai patients with obesity or a difficult anatomy. It also shortened the procedural duration and reduced the incidence of traumatic tap.
- Spinal Puncture
- Ultrasonography, Interventional
- Obesity
- Emergency Service
- Hospital
##submission.howToCite##
参考
Jurado R, Walker HK. Cerebrospinal fluid. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Boston: Butterworths; 1990. Available from: https://www.ncbi.nlm.nih.gov/books/NBK398/
Engelborghs S, Niemantsverdriet E, Struyfs H, Blennow K, Brouns R, Comabella M, et al. Consensus guidelines for lumbar puncture in patients with neurological diseases. Alzheimers Dement (Amst). 2017;8:111-26.
Johnson KS SD. Lumbar puncture: Technique, indications, contraindications, and complications in adults. 2021 [cited 2022 November 27th]. Available from: https://www.uptodate.com/contents/lumbar-puncture-technique-indications-contraindications-and-complications-in-adults. .
Edwards C, Leira EC, Gonzalez-Alegre P. Residency training: a failed lumbar puncture is more about obesity than lack of ability. Neurology. 2015;84(10):e69-72.
Ellenby MS, Tegtmeyer K, Lai S, Braner DA. Videos in clinical medicine. Lumbar puncture. N Engl J Med. 2006;355(13):e12.
Halpenny D, O'Sullivan K, Burke JP, Torreggiani WC. Does obesity preclude lumbar puncture with a standard spinal needle? The use of computed tomography to measure the skin to lumbar subarachnoid space distance in the general hospital population. Eur Radiol. 2013;23(11):3191-6.
Hudgins PA, Fountain AJ, Chapman PR, Shah LM. Difficult Lumbar Puncture: Pitfalls and Tips from the Trenches. AJNR Am J Neuroradiol. 2017;38(7):1276-83.
Neal JT, Kaplan SL, Woodford AL, Desai K, Zorc JJ, Chen AE. The Effect of Bedside Ultrasonographic Skin Marking on Infant Lumbar Puncture Success: A Randomized Controlled Trial. Ann Emerg Med. 2017;69(5):610-9.e1.
Pierce DB, Shivaram G, Koo KSH, Shaw DWW, Meyer KF, Monroe EJ. Ultrasound-guided lumbar puncture in pediatric patients: technical success and safety. Pediatr Radiol. 2018;48(6):875-81.
Stoller JZ, Fraga MV. Real-time ultrasound-guided lumbar puncture in the neonatal intensive care unit. J Perinatol. 2021;41(10):2495-8.
Tirado A, Wu T, Noble VE, Huang C, Lewiss RE, Martin JA, et al. Ultrasound-guided procedures in the emergency department-diagnostic and therapeutic asset. Emerg Med Clin North Am. 2013;31(1):117-49.
Dussourd L, Martinon B, Candille C, Paquier C, Wintenberger C, Dumanoir P, et al. Ultrasonography helps emergency physician identify the best lumbar puncture site under the conus medullaris. Scand J Trauma Resusc Emerg Med. 2017;25(1):60.
Millington SJ, Silva Restrepo M, Koenig S. Better With Ultrasound: Lumbar Puncture. Chest. 2018;154(5):1223-9.
Chin KJ, Perlas A, Chan V, Brown-Shreves D, Koshkin A, Vaishnav V. Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. Anesthesiology. 2011;115(1):94-101.
Lim YC, Choo CY, Tan KT. A randomised controlled trial of ultrasound-assisted spinal anaesthesia. Anaesth Intensive Care. 2014;42(2):191-8.
Nomura JT, Leech SJ, Shenbagamurthi S, Sierzenski PR, O'Connor RE, Bollinger M, et al. A randomized controlled trial of ultrasound-assisted lumbar puncture. J Ultrasound Med. 2007;26(10):1341-8.
Park SK, Bae J, Yoo S, Kim WH, Lim YJ, Bahk JH, et al. Ultrasound-Assisted Versus Landmark-Guided Spinal Anesthesia in Patients With Abnormal Spinal Anatomy: A Randomized Controlled Trial. Anesth Analg. 2020;130(3):787-95.
Perlas A, Chaparro LE, Chin KJ. Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia: A Systematic Review and Meta-Analysis. Reg Anesth Pain Med. 2016;41(2):251-60.
Strony R. Ultrasound-assisted lumbar puncture in obese patients. Crit Care Clin. 2010;26(4):661-4.
Uyel Y, Kilicaslan A. Preprocedural Ultrasonography Versus Landmark-Guided Spinal Anesthesia in Geriatric Patients with Difficult Anatomy: A Prospective Randomized Trial. Eurasian J Med. 2021;53(1):9-14.
Wang Q, Yin C, Wang TL. Ultrasound facilitates identification of combined spinal-epidural puncture in obese parturients. Chin Med J (Engl). 2012;125(21):3840-3.
Evans DP, Tozer J, Joyce M, Vitto MJ. Comparison of Ultrasound-Guided and Landmark-Based Lumbar Punctures in Inexperienced Resident Physicians. J Ultrasound Med. 2019;38(3):613-20.
Grady M, Runyon M, Weekes A, Hogg M, Chaudoin L. Comparison of Ultrasound-Marked Versus Standard Lumbar Puncture Success in Infants. Pediatr Emerg Care. 2022;38(1):e121-e5.
Halkur Shankar S, Biswas S, Kumar A, Gupta A, Goel A, Khan MA, et al. Role of routine use of ultrasonographic guidance for performing lumbar punctures. Postgrad Med J. 2021;97(1143):23-8.
Hayes J, Borges B, Armstrong D, Srinivasan I. Accuracy of manual palpation vs ultrasound for identifying the L3-L4 intervertebral space level in children. Paediatr Anaesth. 2014;24(5):510-5.
Peterson MA, Pisupati D, Heyming TW, Abele JA, Lewis RJ. Ultrasound for routine lumbar puncture. Acad Emerg Med. 2014;21(2):130-6.
Rizk MS, Zeeni CA, Bouez JN, Bteich NJ, Sayyid SK, Alfahel WS, et al. Preprocedural ultrasound versus landmark techniques for spinal anesthesia performed by novice residents in elderly: a randomized controlled trial. BMC Anesthesiol. 2019;19(1):208.
Li L, Tao W, Cai X. Ultrasound-Guided vs. Landmark-Guided Lumbar Puncture for Obese Patients in Emergency Department. Front Surg. 2022;9:874143.
Li Y, Carandang RA, Ade S, Flahive J, Daniello K. Ultrasound-guided lumbar puncture improves success rate and efficiency in overweight patients. Neurol Clin Pract. 2020;10(4):307-13.
World Health Organization, Regional Office for the Western Pacific. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia; 2000. Available from: https://apps.who.int/iris/handle/10665/206936
Euerle BD. Spinal puncture and cerebrospinal fluid examination. In: Roberts JR CC, Thomsen TW, editor. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia: Elsevier; 2019. p. 1258–80.
Park SK, Yoo S, Kim WH, Lim YJ, Bahk JH, Kim JT. Ultrasound-assisted vs. landmark-guided paramedian spinal anaesthesia in the elderly: A randomised controlled trial. Eur J Anaesthesiol. 2019;36(10):763-71.
- 摘要 ##plugins.themes.ojsPlusA.frontend.article.viewed##: 781 ##plugins.themes.ojsPlusA.frontend.article.times##
- pdf (English) ##plugins.themes.ojsPlusA.frontend.article.downloaded##: 588 ##plugins.themes.ojsPlusA.frontend.article.times##
##plugins.themes.ojsPlusA.frontend.article.downloadstatastics##
##plugins.block.makeSubmission.linkLabel##
SJR
COPE
