A COMPARISON OF LUMBAR PUNCTURE WITH AND WITHOUT BEDSIDE ULTRASOUND

Background There is evidence that ultrasound-assisted lumbar puncture (LP) is more effective, and has fewer side effects, than the traditional, palpation based technique. However, neurologists have never published a trial of the method, and the use of ultrasound is not common practice in UK neurology departments. The aim of this study was to compare the efficacy and adverse effects of using ultrasound-assisted versus traditional LP, in a neurology department setting. Methods Consecutive patients undergoing day case LP were randomly assigned to ultrasound-assisted (n=20), or traditional (n=19) LP. Two neurology registrars, previously trained in ultrasound, performed the procedures. We measured success in obtaining CSF, time to mark, patient-rated discomfort, and side effects, including patient-reported post-LP headache. Results Ultrasound-assisted lumbar punctures showed a higher rate of success in obtaining CSF (90% vs 74%), and a lower rate of post-LP headache (20% vs 55%), although neither reached statistical significance. Time to mark was longer with ultrasound (166 s vs 30 s, p=0.0001). Discomfort scores were similar between groups. Conclusion Our experience of bedside ultrasound assisted lumbar puncture is one of a higher success rate and lower post-LP headache rate compared with the traditional technique (although numbers did not reach statistical significance in this small trial).