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