Jones & Bartlett Learning Medicine Blog

    Bedside Ultrasound Increases the Success Rate for Difficult Lumbar Punctures

    Posted by Joseph Esherick on Jul 15, 2011 11:08:52 AM

    Dr. Joseph Esherick Monthly Blog – July 2011

    The traditional landmark-guided needle lumbar puncture technique was first described by Heinrich Quincke in 1891[1]This technique utilizes the iliac crest and the posterior lumbar spinous processes to determine the optimal sites for spinal needle introduction in either the L3-4 or the L2-3 interspinous spaces.  The landmark-guided technique of lumbar puncture is usually successful in experienced hands as long as the patient is not obese, pregnant, edematous, or have scoliosis, degenerative joint disease, or a history of lumbar spine surgery.  Patients who have any of these characteristics or conditions can lead to more difficult landmark-guided lumbar punctures.  It is in these cases when bedside ultrasound can increase the success rate of lumbar punctures.[2,3,4,5]    

    Ultrasound-guided regional neuraxial anesthesia has been described in the anesthesia literature since 1971.[6]   The literature reports a reduction in the number of attempts, need for repositioning, and interspaces accessed compared with landmark-guided spinal or epidural anesthesia.[7,8]  The use of bedside ultrasound to help guide difficult lumbar punctures has spread to the emergency room, ICU, and the hospital wards over the last 7 years.[9]   Observational studies have demonstrated that lumbar landmarks can be correctly identified using ultrasound about 76% of the time when they are difficult to palpate.[2,3,9]

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    Topics: Dr. Joseph Esherick, emergency physician, Heinrich Quincke, Authors, bedside ultrasound, Hospital Medicine Blog, emergency medicine, hospital medicine, hospitalist, landmark-guided, lumbar puncture

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