Efficacy of ultrasound guidance for lumbar punctures: a systematic review and meta-analysis of randomised controlled trials
Brendan Smith, MD
Published July 17, 2024
Probetrotters | Medical Education
Study Design
Meta-analysis of RCTs
Objective
To compare efficacy of ultrasound guided lumbar puncture to palpation techniques
Methods
Selection criteria were limited to lumbar puncture or epidural catheterization in adults, with ultrasound, or palpation. Two reviewers for exclusion. Databases included PubMed, Embase and Cochrane Library.
What are some possible flaws in the methods used?
- Performer bias / specialty
- No blinding to performer of procedure
- Egger’s test bias without post-hoc analysis
Results
Ultrasound guided LP had fewer first attempt failures and fewer subsequent attempts with lower mean success. Ultrasound guidance also had fewer headache and backache complications.
Discussion
Take Home Points
- Ultrasound guided lumbar punctures are superior to palpation techniques with first attempt success and re-attempts.
- This may be more pronounced for non-obstetrics and diagnostic lumbar punctures versus cannulation.
Study Limitations
- Real-time lumbar puncture not compared to palpation or ultrasound identified canulation window.
- The benefit of ultrasound is real-time procedural guidance. Statistical heterogeneity was noted with Egger’s test but not discussed with post-hoc analyses.
Does this study influence your practice?
This study demonstrates that ultrasound guided lumbar punctures will reduce failure attempts. While there was no efficiency saved between techniques of palpation, difficult spinal anatomy or windows for older patients or surgical patients may have greater utility with reduced failures and complications.