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William R Bloom, Cynthia J Roberts, Andrew N Springer, Jyoti Pandya, Robert H Small, Christopher Steven Pappa, Gloria Fleming; Subject experience during guided lumbar puncture in glaucoma research. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5334.
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© ARVO (1962-2015); The Authors (2016-present)
To report subject experience with an ultrasound (US) guided lumbar puncture (LP) in a glaucoma study.
Sixty subjects were prospectively enrolled in an ongoing study investigating translaminar pressure gradient in glaucoma, which included an LP to measure cerebrospinal fluid pressure (CSFP). CSFP was measured with an electronic transducer, zeroed at the level of the spinal canal with the subject in a lateral decubitus position. The risk-reducing features included use of US guidance to place a 27-gauge pencil point spinal needle in the intrathecal space, and a single experienced operator. Three days after the LP, subjects were contacted to inquire about complications and discomfort, which included back discomfort, headache, leg discomfort, neck discomfort and overall discomfort. Each subject was asked to rate discomfort at 3 time points: during numbing, during LP, and during subsequent 3 days. Discomfort was ranked using a verbal numerical rating scale with a range of 0 to 10, where 0 is no discomfort and 10 is maximum possible discomfort. Scores were divided into 4 categories, according to guidelines suggested by Krebs et al. (J Gen Intern Med. 2007) where 0 equaled no discomfort, 1-3 equaled mild discomfort, 4-6 equaled moderate discomfort, and 7-10 equaled severe discomfort. Discomfort level percentages were calculated.
The figures below summarize the discomfort percentages during numbing (Fig 1A), during LP (Fig 1B), and during subsequent 3 days (Fig 2) for 5 areas of discomfort. For overall discomfort, 88% of subjects reported zero to mild discomfort during the numbing; 82% reported zero to mild discomfort during LP; and 98% reported zero to mild discomfort during the 3 days after LP. 90% of subjects reported no headache after LP. 8% reported a mild headache and 2% (1 subject) reported a moderate headache. In all mild cases, post-dural puncture headache (PDPH) was ruled out. The moderate headache described by one subject was atypical for PDPH, although it could not be ruled out. No treatment was required and the headache resolved prior to the phone call. No other complications were reported during the three days following the LP.
The LP procedure described is well-tolerated and safe for research purposes. The electronic transducer allowed use of a small needle, which when combined with US guidance, might reduce the incidence of complications compared to the literature.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Fig. 1A and 1B
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