Comparing Ultrasonography and Surface Landmark-Guided Lumbar Puncture in Patients with Obesity and Difficult Anatomy; a Randomized Controlled Trial
Introduction: Previous studies have shown higher lumbar puncture (LP) success rates when using ultrasound guidance. This study aimed to compare the first-attempt success rate of ultrasound-guided LP with blind technique of needle insertion using the palpable spinal surface landmark in patients with...
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| Format: | Article |
| Language: | English |
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Shahid Beheshti University of Medical Sciences
2023-08-01
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| Series: | Archives of Academic Emergency Medicine |
| Subjects: | |
| Online Access: | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2026 |
| _version_ | 1797739586717220864 |
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| author | Pitsucha Sanguanwit Phantakan Tansuwannarat Chinnarat Bua-Ngam Supakrid Suttabuth Pongsakorn Atiksawedparit Satariya Trakulsrichai |
| author_facet | Pitsucha Sanguanwit Phantakan Tansuwannarat Chinnarat Bua-Ngam Supakrid Suttabuth Pongsakorn Atiksawedparit Satariya Trakulsrichai |
| author_sort | Pitsucha Sanguanwit |
| collection | DOAJ |
| description |
Introduction: Previous studies have shown higher lumbar puncture (LP) success rates when using ultrasound guidance. This study aimed to compare the first-attempt success rate of ultrasound-guided LP with blind technique of needle insertion using the palpable spinal surface landmark in patients with obesity or a difficult anatomy.
Methods: This prospective randomized controlled study was performed at the emergency department of Ramathibodi Hospital, an academic tertiary university hospital, from August 2015 to July 2016.
Results: 40 patients were enrolled (20 surface landmark-guided and 20 ultrasound-guided LPs). 52.5% of the patients were male with the mean age of 60.33 ± 4.24 years. The first-attempt success rate in the ultrasound-guided LP group was significantly higher than the landmark-guided LP group (80% vs. 35%, respectively), with risk difference (RD) of 45.00% (95% confidence interval (CI): 17.72%, 72.28%). This indicated absolute risk reduction and number needed to treat of 45.00% and 2.22, respectively. The median procedural duration required to achieve successful LP in the ultrasound-guided LP group was significantly shorter than the surface landmark-guided LP group (5 [IQR: 3–18] minutes vs. 13.5 [IQR: 5-30] minutes, respectively). Traumatic puncture as a complication occurred less frequently in the ultrasound-guided LP group than the surface landmark-guided LP group with risk ratio (RR) = 0.33 (95% CI: 0.08, 1.46) and RD = -20.00% (95% CI: -44.00%, 4.00%). This indicated absolute risk reduction and number needed to harm of 20.00% and 5.00, respectively. However, the difference was not significant.
Conclusion: Using ultrasound to help localize the insertion point before LP increased the first-attempt success rate and improved other LP outcomes in Thai patients with obesity or a difficult anatomy. It also shortened the procedural duration and reduced the incidence of traumatic tap.
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| first_indexed | 2024-03-12T13:59:19Z |
| format | Article |
| id | doaj.art-f95725a193ca4f14b79fcc802997b8fa |
| institution | Directory Open Access Journal |
| issn | 2645-4904 |
| language | English |
| last_indexed | 2024-03-12T13:59:19Z |
| publishDate | 2023-08-01 |
| publisher | Shahid Beheshti University of Medical Sciences |
| record_format | Article |
| series | Archives of Academic Emergency Medicine |
| spelling | doaj.art-f95725a193ca4f14b79fcc802997b8fa2023-08-22T09:10:39ZengShahid Beheshti University of Medical SciencesArchives of Academic Emergency Medicine2645-49042023-08-0111110.22037/aaem.v11i1.2026Comparing Ultrasonography and Surface Landmark-Guided Lumbar Puncture in Patients with Obesity and Difficult Anatomy; a Randomized Controlled TrialPitsucha Sanguanwit0Phantakan Tansuwannarat1Chinnarat Bua-Ngam2Supakrid Suttabuth3Pongsakorn Atiksawedparit4Satariya Trakulsrichai5Ramathibodi hospitalRamathibodi hospitalRamathibodi hospitalRamathibodi hospitalRamathibodi hospitalRamathibodi Hospital, Mahidol University Introduction: Previous studies have shown higher lumbar puncture (LP) success rates when using ultrasound guidance. This study aimed to compare the first-attempt success rate of ultrasound-guided LP with blind technique of needle insertion using the palpable spinal surface landmark in patients with obesity or a difficult anatomy. Methods: This prospective randomized controlled study was performed at the emergency department of Ramathibodi Hospital, an academic tertiary university hospital, from August 2015 to July 2016. Results: 40 patients were enrolled (20 surface landmark-guided and 20 ultrasound-guided LPs). 52.5% of the patients were male with the mean age of 60.33 ± 4.24 years. The first-attempt success rate in the ultrasound-guided LP group was significantly higher than the landmark-guided LP group (80% vs. 35%, respectively), with risk difference (RD) of 45.00% (95% confidence interval (CI): 17.72%, 72.28%). This indicated absolute risk reduction and number needed to treat of 45.00% and 2.22, respectively. The median procedural duration required to achieve successful LP in the ultrasound-guided LP group was significantly shorter than the surface landmark-guided LP group (5 [IQR: 3–18] minutes vs. 13.5 [IQR: 5-30] minutes, respectively). Traumatic puncture as a complication occurred less frequently in the ultrasound-guided LP group than the surface landmark-guided LP group with risk ratio (RR) = 0.33 (95% CI: 0.08, 1.46) and RD = -20.00% (95% CI: -44.00%, 4.00%). This indicated absolute risk reduction and number needed to harm of 20.00% and 5.00, respectively. However, the difference was not significant. Conclusion: Using ultrasound to help localize the insertion point before LP increased the first-attempt success rate and improved other LP outcomes in Thai patients with obesity or a difficult anatomy. It also shortened the procedural duration and reduced the incidence of traumatic tap. https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2026Spinal PunctureUltrasonography, InterventionalObesityEmergency ServiceHospital |
| spellingShingle | Pitsucha Sanguanwit Phantakan Tansuwannarat Chinnarat Bua-Ngam Supakrid Suttabuth Pongsakorn Atiksawedparit Satariya Trakulsrichai Comparing Ultrasonography and Surface Landmark-Guided Lumbar Puncture in Patients with Obesity and Difficult Anatomy; a Randomized Controlled Trial Archives of Academic Emergency Medicine Spinal Puncture Ultrasonography, Interventional Obesity Emergency Service Hospital |
| title | Comparing Ultrasonography and Surface Landmark-Guided Lumbar Puncture in Patients with Obesity and Difficult Anatomy; a Randomized Controlled Trial |
| title_full | Comparing Ultrasonography and Surface Landmark-Guided Lumbar Puncture in Patients with Obesity and Difficult Anatomy; a Randomized Controlled Trial |
| title_fullStr | Comparing Ultrasonography and Surface Landmark-Guided Lumbar Puncture in Patients with Obesity and Difficult Anatomy; a Randomized Controlled Trial |
| title_full_unstemmed | Comparing Ultrasonography and Surface Landmark-Guided Lumbar Puncture in Patients with Obesity and Difficult Anatomy; a Randomized Controlled Trial |
| title_short | Comparing Ultrasonography and Surface Landmark-Guided Lumbar Puncture in Patients with Obesity and Difficult Anatomy; a Randomized Controlled Trial |
| title_sort | comparing ultrasonography and surface landmark guided lumbar puncture in patients with obesity and difficult anatomy a randomized controlled trial |
| topic | Spinal Puncture Ultrasonography, Interventional Obesity Emergency Service Hospital |
| url | https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2026 |
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