Optimal management after paediatric lumbar puncture: a randomized controlled trial

Bing Hu, Tian-Ming Chen, Bing Liu, Wei Chi, Yi-Qing Miao, Xiao-Lu Nie, Xiao-Xia Peng, Gang Liu, Bing Hu, Tian-Ming Chen, Bing Liu, Wei Chi, Yi-Qing Miao, Xiao-Lu Nie, Xiao-Xia Peng, Gang Liu

Abstract

Background: To evaluate whether a shorter time of lying supine without a pillow and fasting for solids and liquids (LSFSL) after a lumbar puncture (LP) is associated with a higher risk of post-lumbar puncture headache (PLPH) and post-lumbar puncture lower back pain (PLPBP) in a randomized, assessor-blinded, controlled trial.

Methods: Paediatric patients who underwent their first LP after hospital admission were randomly allocated to either the group with half an hour of LSFSL (0.5 h LSFSL) or 4 h of LSFSL (4 h LSFSL) immediately after LP. The primary outcome is PLPH after LP. The incidence of PLPH, PLPBP, and vomiting; vital signs (respiratory rate, heart rate, blood pressure); and other post-procedure conditions after LP were measured as the outcomes. The Non-inferiority test and Wilcoxon rank-sum test were used to analyse the outcome data.

Results: In total, 400 patients (201 in the 0.5-h LSFSL group and 199 in the 4-h LSFSL group) were included in this trial. Twelve (5.97%) of 201 patients experienced PLPH in the 0.5 h LSFSL group versus 13 (6.53%) of 199 patients in the 4 h LSFSL group (difference 0.56, 95% CI -4.18 to 5.31; p = 0·0108 for the non-inferiority test). Fourteen (6.97%) of 201 patients experienced PLPBP in the 0.5 h LSFSL group versus 17 (8.54%) of 199 patients in the 4 h LSFSL group (difference 1.57, 95% CI -3.66 to 6.82; p = 0.007 for the non-inferiority test). The changes in heart rate (HR), respiratory rate (RP) and systolic blood pressure (SBP) before and after the LP were not different between the 0.5-h LSFSL group and the 4-h LSFSL group. No other adverse events were reported.

Conclusions: Compared with 4 h of LSFSL after LP, 0.5 h of LSFSL was not associated with a higher risk of PLPH, PLPBP or other adverse events. In conclusion, 0.5 h of LSFSL is sufficient for children undergoing LP.

Trial registration: Clinical trial NCT02590718 . The date of registration was 08/25/2015.

Keywords: Duration of bed rest; Lumbar puncture; Postoperative complications; Supine position.

Conflict of interest statement

Ethics approval and consent to participate

This research was approved (No.2015–2) by the Ethics Committee of Beijing Children’s Hospital affiliated with Capital Medical University. The protocol (ID: 20150826) was registered in ClinicalTrials.gov. The study was performed after the children and their patents were fully informed. All participants and/or their parents signed an informed consent form and received written and verbal information before participating in this study. All authors read and approved the final manuscript.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of the trial procedure. 0.5-h LSFSL: lying in the supine position without a pillow and fasting for solids and liquids for half an hour after lumbar puncture; 4-h LSFSL: lying in the supine position without a pillow and fasting for solids and liquids for 4 h after lumbar puncture; HR: heart rate; RR: respiratory rate; SBP: systolic blood pressure
Fig. 2
Fig. 2
Mean differences in other physiological indexes after lumber puncture

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