Taking the sting out of lumbar puncture

Lumbar puncture remains an important and commonly performed diagnostic procedure,1 but training for its performance is not standardized.2 Although most diagnostic lumbar punctures are performed by neurologists, hospitalists, emergency department physicians, and pediatricians, physicians in many different specialties should have some experience with lumbar punctures and may on occasion need to perform one.

A well designed linked systematic review and meta-analysis by Shaikh and colleagues (doi:10.1136/bmj.f1720) investigates the benefit of using ultrasound guidance when performing lumbar puncture in routine diagnostic and therapeutic settings and in the performance of epidural catheterizations, mainly for giving anesthesia.3 The meta-analysis looked at 14 randomized studies with results from more than 1300 participants. It found a significant risk reduction for the primary outcome measure of failed procedures for ultrasound guided compared with the traditional anatomic approach to lumbar puncture. Failed procedures were defined conservatively as any failure to achieve the goals intended for the procedure. Epidural catheterizations were judged equivalent …