Position for Lumbar Punctures

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 976-976
Author(s):  
JOAQUIM M.B. PINHEIRO
Keyword(s):  
Clinical Trial ◽  
Head And Neck ◽  
Lumbar Puncture ◽  
Local Anesthesia ◽  
Controlled Clinical Trial ◽  
Lateral Neck ◽  
Physiologic Responses ◽  
Fetal Position

To the Editor.— In "A Controlled Clinical Trial of Local Anesthesia for Lumbar Punctures in Newborns"1 Porter et al reported on their attempt to decrease lumbar puncture-induced physiologic instability by using lidocaine. While the cardiorespiratory measures of physiologic instability were not affected by local anesthesia, they were influenced significantly and adversely by the preparatory procedure (ie, being held flexed in the fetal position). As pointed out by the authors, the position chosen for the procedure, which included knees to chest plus flexion of head and neck has been shown to induce more adverse physiologic responses than either the sitting or the modified lateral (neck not flexed) position.2,3

A Controlled Clinical Trial of Local Anesthesia for Lumbar Punctures in Newborns

PEDIATRICS ◽  
1991 ◽  
Vol 88 (4) ◽  
pp. 663-669 ◽  
Author(s):  
Fran L. Porter ◽  
J. Philip Miller ◽  
F. Sessions Cole ◽  
Richard E. Marshall
Keyword(s):  
Carbon Dioxide ◽  
Clinical Trial ◽  
Heart Rate ◽  
Lumbar Puncture ◽  
Local Anesthesia ◽  
Subcutaneous Administration ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Transcutaneous Oxygen ◽  
Experimental Group

To evaluate the efficacy of subcutaneous administration of lidocaine for reducing physiologic instability in acutely ill newborns during clinically required procedures, 81 neonates who required lumbar punctures within the first month of life were stratified by birth weight and respiratory support and randomly assigned to an experimental or a control group. The experimental group received an injection of 0.1 mL/kg of 1% lidocaine prior to the lumbar puncture. The control group received a nonanesthetized lumbar puncture without placebo. Changes in heart rate, respiratory rate, transcutaneous oxygen and carbon dioxide tensions, and heart rate variability from baseline, preparatory (positioning/handling), lumbar puncture, and recovery periods were measured. The administration of lidocaine did not minimize physiologic instability in response to the lumbar puncture nor was it associated with any detectable adverse effects other than prolonging the duration of the lumbar puncture. Although significant physiologic changes were observed in response to preparatory procedures, few additional changes beyond those occurred in response to lumbar punctures in either the experimental or control group. It is concluded that local anesthesia failed to influence manifestations of physiologic instability during neonatal lumbar punctures and that preparatory procedures were more destabilizing than either the administration of lidocaine or the lumbar puncture itself. The results suggest that the management of newborns requires emphasis on minimizing the destabilizing effects of required and frequent handling procedures.

Role of Local Anesthesia During Lumbar Puncture in Neonates

PEDIATRICS ◽  
1993 ◽  
Vol 91 (2) ◽  
pp. 379-382 ◽  
Author(s):  
Joaquim M.B. Pinheiro ◽  
Sue Furdon ◽  
Luis F. Ochoa
Keyword(s):  
Success Rate ◽  
Lumbar Puncture ◽  
Local Anesthesia ◽  
Needle Insertion ◽  
Control Group ◽  
Anatomical Landmarks ◽  
Control Groups ◽  
Lidocaine Injection ◽  
Level Of Training ◽  
Physiologic Responses

Local anesthesia decreases physiologic responses to pain in neonates but has not been used routinely during lumbar punctures in newborns, as it might obscure anatomical landmarks. However, local anesthesia may decrease newborns' struggling during lumbar puncture, thus facilitating the procedure and increasing its success rate. The success rate of lumbar punctures was compared in neonates allocated prospectively to 0.2 to 0.5 mL of 1% lidocaine anesthesia (n = 48) or a control group (n = 52). Newborns were held in a modified lateral recumbent postion (neck not flexed) and their struggling response to the various steps in the lumbar puncture was scored by the holder. The newborns' struggling motion score increased in response to lidocaine injection, but response to the subsequent spinal needle insertion was significantly decreased. Despite this decreased motion, no differences were noted in the number of attempts per lumbar puncture (1.9 ± 0.2 [SEM] in lidocaine and 2.1 ± 0.2 in control groups), rate of lumbar puncture failure (15% in lidocaine and 19% in control groups), or the number of traumatic lumbar punctures (46% in both groups). The success rate of lumbar puncture was not dependent on level of training of physicians performing the procedure. No acute complications, cerebrospinal fluid contamination, or subsequent meningitis was noted in either group. It is concluded that local anesthesia with lidocaine decreases the degree of struggling but does not alter the success rate of lumbar puncture in neonates. The practice of withholding lidocaine anesthesia from neonates undergoing lumbar punctures cannot be justified by arguing that it makes the procedure more difficult to perform.

Tranexamic acid has no advantage in head and neck surgical procedures: a randomised, double-blind, controlled clinical trial

2019 ◽  
Vol 133 (12) ◽  
pp. 1024-1032
Author(s):  
A Thakur ◽  
S Gupta ◽  
J S Thakur ◽  
R S Minhas ◽  
R K Azad ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Tranexamic Acid ◽  
Head And Neck ◽  
Surgical Procedures ◽  
Primary Tumour ◽  
Blood Parameters ◽  
Controlled Clinical Trial ◽  
Skin Closure ◽  
Double Blind ◽  
The Difference

AbstractObjectiveTo assess the effect of tranexamic acid in head and neck surgical procedures.MethodsA prospective, double-blind and randomised, parallel group, placebo-controlled clinical trial was conducted. Ninety-two patients undergoing various head and neck surgical procedures were randomised. Subjects received seven infusions of coded drugs (tranexamic acid or normal saline) starting at the time of skin closure. Haematological, biochemical, blood loss and other parameters were observed by the staff, who were blinded to patients’ group allocation (case or control).ResultsPatients were analysed on the basis of type of surgery. Fifty patients who had undergone surgical procedures, including total thyroidectomy, total parotidectomy, and various neck dissections with or without primary tumour excision, were included in the first group. The second group comprised 41 patients who had undergone hemithyroidectomy, lobectomy or superficial parotidectomy. There was no statistical difference in blood parameters between both groups. There was a reduction in post-operative drain volume, but this was not significant.ConclusionAlthough this prospective, randomised, placebo-controlled clinical trial found a reduction in post-operative drain volume in tranexamic acid groups, the difference was not statistically significant between the various head and neck surgical procedure groups.

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