THE RESEARCH LUMBAR PUNCTURE: FURTHER EVIDENCE OF SAFETY AND TOLERABILITY WHEN UNDERTAKEN BY EXPERIENCED ANAESTHETISTS

Abstract

The lumbar puncture was described in 1891 by Heinrich Quincke. Its use as a diagnostic aid in the ill patient with central nervous system pathology is well established. Its role as a research tool has a shorter history. With the advent of cerebrospinal fluid biomarkers, the research lumbar puncture is being undertaken more frequently to investigate a variety of conditions. Previous large series show a wide variation in the incidence of complications. In one, the authors report any adverse event as 11.7% and clinically significant adverse events as 3.97%. We have already shown that if undertaken by clinicians experienced in regional anaesthesia the rate of complications is considerably lower. We now describe additional data from our series as further evidence of this theory. In an audit of our practice, we analysed notes of 120 consecutive patients who underwent a lumbar puncture at the Glasgow Memory Clinic between October 2011 and May 2014. They were volunteers having cerebrospinal fluid biomarker analysis as part of commercial studies. All were mildly cognitively impaired or had probable mild Alzheimer's disease. The procedures were carried out two experienced consultant anaesthetists who regularly perform spinal anaesthesia as part of their routine clinical practice. Data was available for 118/120 patients (50 female, 68 male). Mean age 68.6 years. 102/118(86.4%) of procedures were completed at the first attempt, 14 (11.9%) on the second and 2 (1.7%) on the third. 3 patients (2.5%) complained of procedural back pain and 1 (0.8%) of back and leg pain. 2 (1.7%) had transient lower limb paraesthesiae. There were no bloody taps. The procedures were well tolerated with a very small percentage of transient symptoms. In the hands experienced anaesthetists using relatively narrow gauge spinal needles the Research Lumbar Puncture has a very low rate of immediate complications.