Analgesia for lumbar puncture in infants and children

[摘要] Question As a family physician who works in the local community emergency department, my skills include performing lumbar puncture in young children and infants. I hear conflicting recommendations in regard to provision of analgesia during lumbar puncture in these patients. Does local analgesia affect the success rate of the procedure? What is the best practice for analgesia in young children and infants? Answer Lumbar puncture is one of the most commonly encountered painful procedures in pediatric medicine; it is imperative for timely diagnosis of central nervous system infections in febrile young infants. For many years it has been documented that health care providers provide suboptimal analgesia, despite the understanding that this is a painful procedure for infants and children of all ages. Using a lidocaine and prilocaine combination or a 1% lidocaine infiltration (or both) is recommended and has been associated with improved outcomes during the procedure. Lumbar puncture (LP) is a common procedure in pediatrics, performed mostly in the hospital setting. The most common reasons to perform an LP, especially in young febrile infants, are to rule out meningitis and encephalitis, determine a source of inflammation, treat inflammatory conditions such as Guillain-Barré syndrome, diagnose malignancy, and find evidence of bleeding in the area around the brain or spinal cord. For neonates with documented fever, the best practice involves a mandatory LP to rule out bacterial meningitis. ¹ The procedure is extremely common, despite recent propositions for modified Philadelphia criteria that do not include routine cerebrospinal fluid testing while still identifying most infants who are febrile with invasive bacterial infections. ² Research in neonatology in recent decades brought the realization that neonates do experience pain from noxious stimuli and might do so at an even greater intensity than older children or adults. ³ They carry the pain experience with a “memory” and long-term consequences. ⁴

[学科分类] 卫生学