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

doi:10.1007/s00415-020-09797-1

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

Anesthesiology

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

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 language	English
Pages (from-to)	2002-2006
Number of pages	5
Journal	Journal of Neurology
Volume	267
Issue number	7
DOIs	https://doi.org/10.1007/s00415-020-09797-1
State	Published - Jul 1 2020

Bibliographical note

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

Funding

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.

Funders	Funder number
National Institutes of Health Beeson	K76 AG057022
National Institutes of Health (NIH)	GM08600
National Institutes of Health (NIH)
National Institute on Aging	R03AG050918
National Institute on Aging
American Geriatrics Society
Foundation for Anesthesia Education and Research	P30AG028716
Foundation for Anesthesia Education and Research
International Anesthesia Research Society	R03 AG050918
International Anesthesia Research Society

Keywords

Headache
Lumbar puncture
Pain
Protocol

ASJC Scopus subject areas

Neurology
Clinical Neurology

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10.1007/s00415-020-09797-1

Cite this

@article{cda5d6a13e7d4e699485b3723e38f91f,

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

abstract = "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.",

keywords = "Headache, Lumbar puncture, Pain, Protocol",

author = "Nobuhara, {Chloe K.} and Bullock, {W. Michael} and Thomas Bunning and Brian Colin and Mary Cooter and Devinney, {Michael J.} and Ferrandino, {Michael N.} and Jeffrey Gadsden and Grant Garrigues and Habib, {Ashraf S.} and Eugene Moretti and Judd Moul and Brian Ohlendorf and Aaron Sandler and Randall Scheri and Bharat Sharma and Thomas, {Jake P.} and Christopher Young and Mathew, {Joseph P.} and Miles Berger and Amundsen, {C. L.} and P. Avasarala and Berry, {M. F.} and Blazer, {D. G.} and Bolognesi, {M. P.} and R. Brassard and Brigman, {B. E.} and Browndyke, {J. N.} and V. Cai and J. Carter and J. Chapman and C. Chen and V. Cheong and S. Christensen and Cohen, {H. J.} and DeOrio, {J. K.} and D{\textquoteright}Amico, {T. A.} and D. Erdmann and Esclamado, {R. M.} and B. Funk and S. Grant and J. Guercio and Gupta, {D. K.} and Harpole, {D. H.} and Hartwig, {M. G.} and Hollenbeck, {S. T.} and E. Iboaya and Inman, {B. A.} and Jang, {D. W.} and Newman, {M. F.}",

note = "Publisher Copyright: {\textcopyright} 2020, Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2020",

month = jul,

day = "1",

doi = "10.1007/s00415-020-09797-1",

language = "English",

volume = "267",

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T1 - A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults

AU - Nobuhara, Chloe K.

AU - Bullock, W. Michael

AU - Bunning, Thomas

AU - Colin, Brian

AU - Cooter, Mary

AU - Devinney, Michael J.

AU - Ferrandino, Michael N.

AU - Gadsden, Jeffrey

AU - Garrigues, Grant

AU - Habib, Ashraf S.

AU - Moretti, Eugene

AU - Moul, Judd

AU - Ohlendorf, Brian

AU - Sandler, Aaron

AU - Scheri, Randall

AU - Sharma, Bharat

AU - Thomas, Jake P.

AU - Young, Christopher

AU - Mathew, Joseph P.

AU - Berger, Miles

AU - Amundsen, C. L.

AU - Avasarala, P.

AU - Berry, M. F.

AU - Blazer, D. G.

AU - Bolognesi, M. P.

AU - Brassard, R.

AU - Brigman, B. E.

AU - Browndyke, J. N.

AU - Cai, V.

AU - Carter, J.

AU - Chapman, J.

AU - Chen, C.

AU - Cheong, V.

AU - Christensen, S.

AU - Cohen, H. J.

AU - DeOrio, J. K.

AU - D’Amico, T. A.

AU - Erdmann, D.

AU - Esclamado, R. M.

AU - Funk, B.

AU - Grant, S.

AU - Guercio, J.

AU - Gupta, D. K.

AU - Harpole, D. H.

AU - Hartwig, M. G.

AU - Hollenbeck, S. T.

AU - Iboaya, E.

AU - Inman, B. A.

AU - Jang, D. W.

AU - Newman, M. F.

PY - 2020/7/1

Y1 - 2020/7/1

N2 - 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.

AB - 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.

KW - Headache

KW - Lumbar puncture

KW - Pain

KW - Protocol

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U2 - 10.1007/s00415-020-09797-1

DO - 10.1007/s00415-020-09797-1

M3 - Article

C2 - 32198714

AN - SCOPUS:85082050889

SN - 0340-5354

VL - 267

SP - 2002

EP - 2006

JO - Journal of Neurology

JF - Journal of Neurology

IS - 7

ER -

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

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

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