Chloe K Nobuhara1, W Michael Bullock1, Thomas Bunning1, Brian Colin1, Mary Cooter1, Michael J Devinney1, Michael N Ferrandino2, Jeffrey Gadsden1, Grant Garrigues3,4, Ashraf S Habib1, Eugene Moretti1, Judd Moul2, Brian Ohlendorf1, Aaron Sandler1, Randall Scheri5, Bharat Sharma1, Jake P Thomas1, Christopher Young1, Joseph P Mathew1, Miles Berger6,7,8. 1. Department of Anesthesiology, Duke University Medical Center, Duke South Orange Zone, Rm 4317, Box 3094, Durham, NC, 27710, USA. 2. Urology Division, Department of Surgery, Duke University Medical Center, Durham, NC, USA. 3. Department of Orthopedics, Duke University Medical Center, Durham, NC, USA. 4. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA. 5. Department of Surgery, Duke University Medical Center, Durham, NC, USA. 6. Department of Anesthesiology, Duke University Medical Center, Duke South Orange Zone, Rm 4317, Box 3094, Durham, NC, 27710, USA. miles.berger@duke.edu. 7. Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA. miles.berger@duke.edu. 8. Center for Cognitive Neuroscience and the Duke Institute for Brain Sciences, Duke University, Durham, NC, USA. miles.berger@duke.edu.
Abstract
OBJECTIVE: Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort studies who underwent LPs using a standardized protocol and 25 g needle. METHODS: Eight hundred and nine LPs performed in 262 patients age ≥ 60 years in the MADCO-PC and INTUIT studies were analyzed. Medical records were monitored for LP-related adverse events, and patients were queried about subjective complaints. We analyzed adverse event rates, including headaches and pain scores. RESULTS: There were 22 adverse events among 809 LPs performed, a rate of 2.72% (95% CI 1.71-4.09%). Patient hospital stay did not increase due to adverse events. Four patients (0.49%) developed a post-lumbar puncture headache (PLPH). Twelve patients (1.48%) developed nausea, vasovagal responses, or headaches that did not meet PLPH criteria. Six patients (0.74%) reported lower back pain at the LP site not associated with muscular weakness or paresthesia. The median pain score was 1 [0, 3]; the mode was 0 out of 10. CONCLUSIONS: The LP protocol described herein may reduce adverse event rates and improve patient comfort in future studies.
OBJECTIVE: Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort studies who underwent LPs using a standardized protocol and 25 g needle. METHODS: Eight hundred and nine LPs performed in 262 patients age ≥ 60 years in the MADCO-PC and INTUIT studies were analyzed. Medical records were monitored for LP-related adverse events, and patients were queried about subjective complaints. We analyzed adverse event rates, including headaches and pain scores. RESULTS: There were 22 adverse events among 809 LPs performed, a rate of 2.72% (95% CI 1.71-4.09%). Patient hospital stay did not increase due to adverse events. Four patients (0.49%) developed a post-lumbar puncture headache (PLPH). Twelve patients (1.48%) developed nausea, vasovagal responses, or headaches that did not meet PLPH criteria. Six patients (0.74%) reported lower back pain at the LP site not associated with muscular weakness or paresthesia. The median pain score was 1 [0, 3]; the mode was 0 out of 10. CONCLUSIONS: The LP protocol described herein may reduce adverse event rates and improve patient comfort in future studies.
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