A positioning pillow to improve lumbar puncture success rate in paediatric haematology-oncology patients: a randomized controlled trial

Perrine Marec-Bérard, Alvine Bissery, Kamila Kebaïli, Matthias Schell, Françoise Aubert, Ségolène Gaillard, Muriel Rabilloud, Behrouz Kassaï, Catherine Cornu, Perrine Marec-Bérard, Alvine Bissery, Kamila Kebaïli, Matthias Schell, Françoise Aubert, Ségolène Gaillard, Muriel Rabilloud, Behrouz Kassaï, Catherine Cornu

Abstract

Background: Lumbar punctures (LPs) are common in children with cancer. Although pain management during the lumbar puncture has been well standardized, dealing with stress and anxiety is not well addressed yet. Our objective was to evaluate the potential improvement of the LP success rate using a positioning pillow, to ensure maximum lumbar flexion, and allow paravertebral muscles to relax, in children who are awake, with either conscious sedation or no sedation.

Methods: Children aged 2-18 years undergoing LP were randomly assigned to a positioning pillow or no intervention. The primary outcome was the rate of success, i.e. achieving the LP (sampling or injection) at the first attempt, without bleeding (RBC < 50/mm3). The secondary outcomes included: the child's pain, assessed by a self-administered visual analogical scales (VAS) for children over 6 years of age; the parents' and caregivers' perception of the child's pain; the satisfaction of the children, the parents, the caregivers and the physician. The child's cooperation and the occurrence of post-LP syndrome were also evaluated.

Results: 124 children (62 in each group) were included. The LP pillow tended to increase the success rate of LPs (67% vs. 57%, p = 0.23), and decreased the post-LP syndromes (15% vs. 24%, p = 0.17) but the differences were not statistically significant. In children over 6-year of age (n = 72), the rate of success was significantly higher in the pillow group (58.5% vs. 41.5%, p = 0.031), with a tendency to feel less pain (median VAS 25 vs. 15 mm, p = 0.39) and being more satisfied (84.4% vs. 75.0%, p = 0.34).

Conclusion: Overall results do not demonstrate a benefit in using this pillow for lumbar punctures. This study results also suggest a benefit in the sub group of children over 6-year of age; this result needs confirmation.

Trial registration: ClinicalTrials.gov NCT00775112.

Figures

Figure 1
Figure 1
Illustration: The LP pillow is placed on the thighs of the child; it includes side supports for the head, openings to allow the child to breathe and speak, to touch the child's hands and forearms and be able to administrate nitrous oxide, N2O-O2. Props supporting the patient's arms maintain the cervical column in a neutral position.
Figure 2
Figure 2
flow diagram of the progress through the study.

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