. 2020 Jul;267(7):2002-2006.

doi: 10.1007/s00415-020-09797-1. Epub 2020 Mar 20.

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

Chloe K Nobuhara¹, W Michael Bullock¹, Thomas Bunning¹, Brian Colin¹, Mary Cooter¹, Michael J Devinney¹, Michael N Ferrandino², Jeffrey Gadsden¹, Grant Garrigues^{3

4}, Ashraf S Habib¹, Eugene Moretti¹, Judd Moul², Brian Ohlendorf¹, Aaron Sandler¹, Randall Scheri⁵, Bharat Sharma¹, Jake P Thomas¹, Christopher Young¹, Joseph P Mathew¹, Miles Berger^{6

7

8}; MADCO-PC and INTUIT Investigators Teams

Collaborators, Affiliations

Collaborators

MADCO-PC and INTUIT Investigators Teams:
C L Amundsen, P Avasarala, M F Berry, D G Blazer, M P Bolognesi, R Brassard, B E Brigman, J N Browndyke, V Cai, J Carter, J Chapman, C Chen, V Cheong, S Christensen, H J Cohen, J K DeOrio, T A D'Amico, D Erdmann, R M Esclamado, B Funk, S Grant, J Guercio, D K Gupta, D H Harpole, M G Hartwig, S T Hollenbeck, E Iboaya, B A Inman, D W Jang, J Kaisen, A Khan, R Huang, S Lagoo-Deenadayalan, P S Lee, W T Lee, J Lemm, H Levinson, M E Lipkin, D McDonagh, D Murdoch, C R Mantyh, D L McDonagh, J Migaly, S K Mithani, P Mosca, D Murdoch, M F Newman, K Ni, M W Onaitis, D Oyeyemi, T N Pappas, A N Perez, A C Peterson, T J Polascik, A Podgoreanu, P Potash, G M Preminger, Q J Quinones, E N Rampersaud, A Renne, C N Robertson, S A Roman, S Runyon, C D Scales, S Smani, K Smith, M Stang, A Syed, L Talbot, J K M Thacker, J Thomas, B C Tong, Y Toulgoat-Dubois, A Tu, S N Vaslef, N Waldron, X Wang, K Weinhold, S S Wellman, H Whitson, T Wickenheisser, S Zani

Affiliations

¹ Department of Anesthesiology, Duke University Medical Center, Duke South Orange Zone, Rm 4317, Box 3094, Durham, NC, 27710, USA.
² Urology Division, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
³ Department of Orthopedics, Duke University Medical Center, Durham, NC, USA.
⁴ Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
⁵ Department of Surgery, Duke University Medical Center, Durham, NC, USA.
⁶ Department of Anesthesiology, Duke University Medical Center, Duke South Orange Zone, Rm 4317, Box 3094, Durham, NC, 27710, USA. miles.berger@duke.edu.
⁷ Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA. miles.berger@duke.edu.
⁸ Center for Cognitive Neuroscience and the Duke Institute for Brain Sciences, Duke University, Durham, NC, USA. miles.berger@duke.edu.

PMID: 32198714
PMCID: PMC7336280
DOI: 10.1007/s00415-020-09797-1

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

Chloe K Nobuhara et al. J Neurol. 2020 Jul.

. 2020 Jul;267(7):2002-2006.

doi: 10.1007/s00415-020-09797-1. Epub 2020 Mar 20.

Authors

Collaborators

MADCO-PC and INTUIT Investigators Teams:
C L Amundsen, P Avasarala, M F Berry, D G Blazer, M P Bolognesi, R Brassard, B E Brigman, J N Browndyke, V Cai, J Carter, J Chapman, C Chen, V Cheong, S Christensen, H J Cohen, J K DeOrio, T A D'Amico, D Erdmann, R M Esclamado, B Funk, S Grant, J Guercio, D K Gupta, D H Harpole, M G Hartwig, S T Hollenbeck, E Iboaya, B A Inman, D W Jang, J Kaisen, A Khan, R Huang, S Lagoo-Deenadayalan, P S Lee, W T Lee, J Lemm, H Levinson, M E Lipkin, D McDonagh, D Murdoch, C R Mantyh, D L McDonagh, J Migaly, S K Mithani, P Mosca, D Murdoch, M F Newman, K Ni, M W Onaitis, D Oyeyemi, T N Pappas, A N Perez, A C Peterson, T J Polascik, A Podgoreanu, P Potash, G M Preminger, Q J Quinones, E N Rampersaud, A Renne, C N Robertson, S A Roman, S Runyon, C D Scales, S Smani, K Smith, M Stang, A Syed, L Talbot, J K M Thacker, J Thomas, B C Tong, Y Toulgoat-Dubois, A Tu, S N Vaslef, N Waldron, X Wang, K Weinhold, S S Wellman, H Whitson, T Wickenheisser, S Zani

Affiliations

¹ Department of Anesthesiology, Duke University Medical Center, Duke South Orange Zone, Rm 4317, Box 3094, Durham, NC, 27710, USA.
² Urology Division, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
³ Department of Orthopedics, Duke University Medical Center, Durham, NC, USA.
⁴ Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
⁵ Department of Surgery, Duke University Medical Center, Durham, NC, USA.
⁶ Department of Anesthesiology, Duke University Medical Center, Duke South Orange Zone, Rm 4317, Box 3094, Durham, NC, 27710, USA. miles.berger@duke.edu.
⁷ Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA. miles.berger@duke.edu.
⁸ Center for Cognitive Neuroscience and the Duke Institute for Brain Sciences, Duke University, Durham, NC, USA. miles.berger@duke.edu.

PMID: 32198714
PMCID: PMC7336280
DOI: 10.1007/s00415-020-09797-1

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.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflict of Interest

MB acknowledges income from a legal consulting cases related to postoperative cognition in older adults, and material support from Massimo for a study unrelated to the data presented here. MB has also taken part in a peer-to-peer consulting session for Massimo, for which his honorarium was donated (at his request) to the Foundation for Anesthesia Education & Research. The other authors declare that they have no conflict of interest.

Figures

**Figure 1.**
Distribution of self-reported pain scores of INTUIT patients following LP. Stacked bar chart demarcates if the LP was performed at the pre-operative, post-operative, 6-week follow up, or 1 year follow up time points.

See this image and copyright information in PMC

References

1. Duits FH, Martinez-Lage P, Paquet C, Engelborghs S, Lleo A, Hausner L, Molinuevo JL, Stomrud E, Farotti L, Ramakers I, Tsolaki M, Skarsgard C, Astrand R, Wallin A, Vyhnalek M, Holmber-Clausen M, Forlenza OV, Ghezzi L, Ingelsson M, Hoff EI, Roks G, de Mendonca A, Papma JM, Izagirre A, Taga M, Struyfs H, Alcolea DA, Frolich L, Balasa M, Minthon L, Twisk JWR, Persson S, Zetterberg H, van der Flier WM, Teunissen CE, Scheltens P, Blennow K (2016) Performance and complications of lumbar puncture in memory clinics: Results of the multicenter lumbar puncture feasibility study. Alzheimer’s & dementia : the journal of the Alzheimer’s Association 12 (2):154–163. doi:10.1016/j.jalz.2015.08.003 - DOI - PubMed
1. Monserrate AE, Ryman DC, Ma S, Xiong C, Noble JM, Ringman JM, Morris JC, Danek A, Muller-Sarnowski F, Clifford DB, McDade EM, Brooks WS, Darby DG, Masters CL, Weston PS, Farlow MR, Graff-Radford NR, Salloway SP, Fagan AM, Oliver A, Bateman RJ (2015) Factors associated with the onset and persistence of post-lumbar puncture headache. JAMA neurology 72 (3):325–332. doi:10.1001/jamaneurol.2014.3974 - DOI - PMC - PubMed
1. van Oosterhout WP, van der Plas AA, van Zwet EW, Zielman R, Ferrari MD, Terwindt GM (2013) Postdural puncture headache in migraineurs and nonheadache subjects: a prospective study. Neurology 80 (10):941–948. doi:10.1212/WNL.0b013e3182840bf6 - DOI - PMC - PubMed
1. Vidoni ED, Morris JK, Raider K, Burns JM, Alzheimer’s Disease Neuroimaging I (2014) Reducing post-lumbar puncture headaches with small bore atraumatic needles. J Clin Neurosci 21 (3):536–537. doi:10.1016/j.jocn.2013.07.001 - DOI - PMC - PubMed
1. Connick RM, Connick P, Klotsas AE, Tsagkaraki PA, Gkrania-Klotsas E (2009) Procedural confidence in hospital based practitioners: implications for the training and practice of doctors at all grades. In: BMC Med Educ, vol 9 p 2. doi:10.1186/1472-6920-9-2 - DOI - PMC - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources