Lumbar Puncture Medication

  • Author: Gil Z Shlamovitz, MD; Chief Editor: Helmi L Lutsep, MD   more...
 
Updated: May 8, 2012
 

Medication Summary

The amount of lidocaine provided in most kits is often inadequate. The authors recommend supplementing the kit with a 10-mL syringe and a bottle of 1% lidocaine. Make sure not to exceed the maximal recommend dose of 4.5 mg/kg of lidocaine. A smaller needle (27 gauge, 1.25 in.) may be used for infiltration. Smaller needles are shown to be associated with less pain during local anesthesia.

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Local Anesthetics

Class Summary

Local anesthetic agents are used to increase patient comfort during the procedure.

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Lidocaine

 

Lidocaine is an amide local anesthetic used in a 1-2% concentration. This agent inhibits depolarization of type C sensory neurons by blocking sodium channels. Epinephrine prolongs the effect and enhances hemostasis (maximum epinephrine dose, 4.5-7 mg/kg).

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Contributor Information and Disclosures
Author

Gil Z Shlamovitz, MD  Assistant Professor, Section of Emergency Medicine, Baylor College of Medicine; Director of Medical Informatics, Emergency Center, Ben Taub General Hospital

Gil Z Shlamovitz, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Nirav R Shah, MD, MPH  Commissioner, New York State Department of Health

Nirav R Shah, MD, MPH is a member of the following medical societies: American College of Physicians, New York Academy of Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD  Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, Oregon Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association

Disclosure: Co-Axia Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Concentric Medical Consulting fee Review panel membership

Additional Contributors

Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article.

References

  1. Farley A, McLafferty E. Lumbar puncture. Nurs Stand. Feb 6-12 2008;22(22):46-8. [Medline].

  2. Reichman E, Simon RR. Emergency Medicine Procedures. New York, NY: McGraw-Hill; 2004.

  3. Roberts JR, Hedges JR. Clinical Procedures in Emergency Medicine. 4th. Philadelphia, PA: Saunders; 2004.

  4. Cooper N. Lumbar puncture. Acute Med. 2011;10(4):188-93.

  5. de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med. Nov 14 2002;347(20):1549-56. [Medline]. [Full Text].

  6. Petzold A, Brettschneider J, Jin K, et al. CSF protein biomarkers for proximal axonal damage improve prognostic accuracy in the acute phase of Guillain-Barré syndrome. Muscle Nerve. Jul 2009;40(1):42-9. [Medline].

  7. Chern JJ, Tubbs RS, Gordon AS, Donnithorne KJ, Oakes WJ. Management of pediatric patients with pseudotumor cerebri. Childs Nerv Syst. Jan 19 2012;[Epub ahead of print].

  8. Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med. Dec 13 2001;345(24):1727-33. [Medline]. [Full Text].

  9. Baraff LJ, Byyny RL, Probst MA, Salamon N, Linetsky M, Mower WR. Prevalence of herniation and intracranial shift on cranial tomography in patients with subarachnoid hemorrhage and a normal neurologic examination. Acad Emerg Med. Apr 2010;17(4):423-8. [Medline].

  10. Boesiger BM, Shiber JR. Subarachnoid hemorrhage diagnosis by computed tomography and lumbar puncture: are fifth generation CT scanners better at identifying subarachnoid hemorrhage?. J Emerg Med. Jul 2005;29(1):23-7. [Medline].

  11. Joffe AR. Lumbar puncture and brain herniation in acute bacterial meningitis: a review. J Intensive Care Med. Jul-Aug 2007;22(4):194-207. [Medline].

  12. Oliver WJ, Shope TC, Kuhns LR. Fatal lumbar puncture: fact versus fiction--an approach to a clinical dilemma. Pediatrics. Sep 2003;112(3 Pt 1):e174-6. [Medline].

  13. Lambert DH, Hurley RJ, Hertwig L, Datta S. Role of needle gauge and tip configuration in the production of lumbar puncture headache. Reg Anesth. Jan-Feb 1997;22(1):66-72. [Medline].

  14. [Best Evidence] Lavi R, Yarnitsky D, Yernitzky D, Rowe JM, Weissman A, Segal D. Standard vs atraumatic Whitacre needle for diagnostic lumbar puncture: a randomized trial. Neurology. Oct 24 2006;67(8):1492-4. [Medline].

  15. Lavi R, Rowe JM, Avivi I. Traumatic vs. atraumatic 22 G needle for therapeutic and diagnostic lumbar puncture in the hematologic patient: a prospective clinical trial. Haematologica. Jul 2007;92(7):1007-8. [Medline].

  16. Tung CE, So YT, Lansberg MG. Cost comparison between the atraumatic and cutting lumbar puncture needles. Neurology. Jan 10 2012;78(2):109-13. Epub 2011 Dec 28.

  17. Spriggs DA, Burn DJ, French J, et al. Is bed rest useful after diagnostic lumbar puncture?. Postgrad Med J. Jul 1992;68(801):581-3. [Medline].

  18. Ebinger F, Kosel C, Pietz J, Rating D. Strict bed rest following lumbar puncture in children and adolescents is of no benefit. Neurology. Mar 23 2004;62(6):1003-5. [Medline].

  19. Teece S, Crawford I. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Bed rest after lumbar puncture. Emerg Med J. Sep 2002;19(5):432-3. [Medline].

  20. Ahmed SV, Jayawarna C, Jude E. Post lumbar puncture headache: diagnosis and management. Postgrad Med J. Nov 2006;82(973):713-6. [Medline].

  21. Kim HJ, Cho YJ, Cho JY, Lee DH, Hong KS. Acute subdural hematoma following spinal cerebrospinal fluid drainage in a patient with freezing of gait. J Clin Neurol. Jun 2009;5(2):95-6. [Medline].

  22. Lenelle L, Lahaye-Goffart B, Dewandre PY, Brichant JF. [Post-dural puncture headache: treatment and prevention]. Rev Med Liege. Nov 2011;66(11):575-80. [Article in French].

  23. Majd SA, Pourfarzam S, Ghasemi H, Yarmohammadi ME, Davati A, Jaberian M. Evaluation of pre lumbar puncture position on post lumbar puncture headache. J Res Med Sci. Mar 2011;16(3):282-6.

  24. Aronson PL, Zonfrillo MR. Epidural cerebrospinal fluid collection after lumbar puncture. Pediatr Emerg Care. Jul 2009;25(7):467-8. [Medline].

  25. Hatfield MK, Handrich SJ, Willis JA, Beres RA, Zaleski GX. Blood patch rates after lumbar puncture with Whitacre versus Quincke 22- and 20-gauge spinal needles. AJR Am J Roentgenol. Jun 2008;190(6):1686-9. [Medline].

  26. Avery RA, Mistry RD, Shah SS, Boswinkel J, Huh JW, Ruppe MD, et al. Patient Position During Lumbar Puncture has no Meaningful Effect on Cerebrospinal Opening Pressure in Children. J Child Neurol. Feb 22 2010;[Medline].

  27. Lee LC, Sennett M, Erickson JM. Prevention and management of post-lumbar puncture headache in pediatric oncology patients. J Pediatr Oncol Nurs. Jul-Aug 2007;24(4):200-7. [Medline].

  28. Roberts JR, Hedges JR. Clinical Procedures in Emergency Medicine. 5th ed. 2009.

  29. Tintinalli J, Stapczynski J. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. 2010.

 
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Lumbar puncture disposable tray. Image courtesy of Gil Z Shlamovitz, MD.
Lumbar puncture lateral recumbent position. Image courtesy of Gil Z Shlamovitz, MD.
Lumbar puncture sitting position. Image courtesy of Gil Z Shlamovitz, MD.
L3-L4 interspace palpation. Image courtesy of Gil Z Shlamovitz, MD.
CSF collection tubes. Image courtesy of Gil Z Shlamovitz, MD.
Skin preparation. Video courtesy of Gil Z Shlamovitz, MD.
Drape application. Video courtesy of Gil Z Shlamovitz, MD.
Local anesthesia. Video courtesy of Gil Z Shlamovitz, MD.
Spinal needle insertion. Video courtesy of Gil Z Shlamovitz, MD.
Spinal needle removal. Video courtesy of Gil Z Shlamovitz, MD.
Opening pressure measurement. Video courtesy of Gil Z Shlamovitz, MD.
 
 
 
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