A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults

• Published in: Journal of neurology 2020-07, Vol.267 (7), p.2002-2006
• Main Authors: Nobuhara, Chloe K., Bullock, W. Michael, Bunning, Thomas, Colin, Brian, Cooter, Mary, Devinney, Michael J., Ferrandino, Michael N., Gadsden, Jeffrey, Garrigues, Grant, Habib, Ashraf S., Moretti, Eugene, Moul, Judd, Ohlendorf, Brian, Sandler, Aaron, Scheri, Randall, Sharma, Bharat, Thomas, Jake P., Young, Christopher, Mathew, Joseph P., Berger, Miles
• Format: Article
• Language: English
• Subjects: Aged; Cerebrospinal fluid; Clinical Protocols; Cohort Studies; Female; Headache; Humans; Low back pain; Low Back Pain - diagnosis; Low Back Pain - prevention & control; Male; Medical records; Medicine; Medicine & Public Health; Middle Aged; Nausea; Neurology; Neuroradiology; Neurosciences; Original Communication; Outcome and Process Assessment, Health Care; Pain; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - prevention & control; Pain, Procedural - diagnosis; Pain, Procedural - prevention & control; Paresthesia; Patients; Self Report; Spinal Puncture - adverse effects; Spinal Puncture - standards; Spinal Puncture - statistics & numerical data
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-020-09797-1

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.