A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults

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12 Scopus citations


Objective: Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort studies who underwent LPs using a standardized protocol and 25 g needle. Methods: Eight hundred and nine LPs performed in 262 patients age ≥ 60 years in the MADCO-PC and INTUIT studies were analyzed. Medical records were monitored for LP-related adverse events, and patients were queried about subjective complaints. We analyzed adverse event rates, including headaches and pain scores. Results: There were 22 adverse events among 809 LPs performed, a rate of 2.72% (95% CI 1.71–4.09%). Patient hospital stay did not increase due to adverse events. Four patients (0.49%) developed a post-lumbar puncture headache (PLPH). Twelve patients (1.48%) developed nausea, vasovagal responses, or headaches that did not meet PLPH criteria. Six patients (0.74%) reported lower back pain at the LP site not associated with muscular weakness or paresthesia. The median pain score was 1 [0, 3]; the mode was 0 out of 10. Conclusions: The LP protocol described herein may reduce adverse event rates and improve patient comfort in future studies.

Original languageEnglish
Pages (from-to)2002-2006
Number of pages5
JournalJournal of Neurology
Issue number7
StatePublished - Jul 1 2020

Bibliographical note

Funding Information:
This work was supported by National Institutes of Health (Bethesda, Maryland) T32 Grant No. GM08600 (to MB), an International Anesthesia Research Society (IARS; San Francisco, California) Mentored Research Award (to MB), National Institutes of Health R03 AG050918 (to MB), National Institutes of Health Beeson K76 AG057022 (to MB), a Jahnigen Scholars Fellowship award from the American Geriatrics Society (New York, New York) and the Foundation for Anesthesia Education and Research (to MB), additional support from National Institutes of Health P30AG028716, and Duke Anesthesiology departmental funds.

Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.


  • Headache
  • Lumbar puncture
  • Pain
  • Protocol

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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