Comparison of success rates in performing lumbar puncture and reduction of its anxiety and pain between standard sitting and lateral decubitus positions in 1 to 5-year-old children

Lumbar puncture (LP) is a worth procedure in diagnosis of oncological diseases and intrathecal administration of antineoplastic drugs. The effort should be to minimize pain of LP in children with cancers. This clinical trial was done to compare success rates in performing LP and reducing anxiety and pain of LP in sitting and lateral decubitus positions in 1 to 5-year-old children.

In a not-blinded clinical trial, 80 children aged 1-5 years, undergoing LP in Pediatric Ward of Shahid Sadoughi Hospital, Yazd, Iran, from May to September 2019, were randomly allocated to two groups. Intravenous 0.5mg/kg midazolam was injected in all patients five minutes before LP, and LP was performed in sitting position in group I and in lateral decubitus position in group II. Primary outcomes included rate of successful LP, anxiety and pain scores before LP and during needle insertion to skin for LP, and secondary outcomes comprised of success rates in decrease of anxiety (anxiety score of four and more) and pain (pain score of less than three) when the needle was inserted to skin for LP.

Thirty-eight girls and 42 boys with the mean age of 2.51 ± 0.32 years were evaluated. Success rates in performing LP (70 % in sitting vs. 65% in decubitus position, P=0.5), decrease of LP anxiety (77 % in sitting vs. 75% in decubitus groups, P=0.8) and reduction of pain during skin needle insertion for LP (72 % in sitting vs. 67% in decubitus position, P=0.7) were not significantly different between the two positions.

Rates of success in performing LP and reduction of its pain and anxiety in children were equal in lateral decubitus and sitting posi tions and, in 1 to 5-year-old sick children with or without cardiorespiratory difficulties, LP can be done in lateral decubitus or sitting position.