Abstract
BackgroundLumbar 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.MethodsChildren 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.Results124 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).ConclusionOverall 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 RegistrationThe trial was registered with Clinical Trials.gov (number NCT00775112).
Highlights
Lumbar punctures (LPs) are common in children with cancer
When LPs are performed in a good position, pain is well controlled by local anaesthesia
To decrease discomfort and apprehension, and to improve the position of the patient during the LP, we developed a positioning pillow
Summary
Lumbar punctures (LPs) are common in children with cancer. 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. Lumbar punctures (LP) are commonly performed for diagnosis or treatment purposes in children with cancer or haematological diseases. When LPs are performed in a good position, pain is well controlled by local anaesthesia. LP causes anxiety and stress [2], leading to a high rate of samples being traumatic or hemorrhagic. Success was defined as a LP achieving its objective at the first attempt (sampling or injection), and a RBC ≤ 50/mm
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