A positioning pillow to improve lumbar puncture success rate in paediatric haematology-oncology patients: a randomized controlled trial.
BACKGROUND
Lumbar punctures (LPs) are common in children with cancer. Although pain management during the lumbar puncture has been well standardized, dealing with stress and anxiety is not well addressed yet. Our objective was to evaluate the potential improvement of the LP success rate using a positioning pillow, to ensure maximum lumbar flexion, and allow paravertebral muscles to relax, in children who are awake, with either conscious sedation or no sedation.


METHODS
Children aged 2-18 years undergoing LP were randomly assigned to a positioning pillow or no intervention. The primary outcome was the rate of success, i.e. achieving the LP (sampling or injection) at the first attempt, without bleeding (RBC < 50/mm3). The secondary outcomes included: the child's pain, assessed by a self-administered visual analogical scales (VAS) for children over 6 years of age; the parents' and caregivers' perception of the child's pain; the satisfaction of the children, the parents, the caregivers and the physician. The child's cooperation and the occurrence of post-LP syndrome were also evaluated.


RESULTS
124 children (62 in each group) were included. The LP pillow tended to increase the success rate of LPs (67% vs. 57%, p = 0.23), and decreased the post-LP syndromes (15% vs. 24%, p = 0.17) but the differences were not statistically significant. In children over 6-year of age (n = 72), the rate of success was significantly higher in the pillow group (58.5% vs. 41.5%, p = 0.031), with a tendency to feel less pain (median VAS 25 vs. 15 mm, p = 0.39) and being more satisfied (84.4% vs. 75.0%, p = 0.34).


CONCLUSIONS
Overall results do not demonstrate a benefit in using this pillow for lumbar punctures. This study results also suggest a benefit in the sub group of children over 6-year of age; this result needs confirmation.
Marec-Bérard
Perrine
P
Service d'Oncologie Pédiatrique, Institut d'Hémato-Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France. marec@lyon.fnclcc.fr
Bissery
Alvine
A
Kebaïli
Kamila
K
Schell
Matthias
M
Aubert
Françoise
F
Gaillard
Ségolène
S
Rabilloud
Muriel
M
Kassaï
Behrouz
B
Cornu
Catherine
C
D000293:Adolescent; D000367:Age Factors; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006261:Headache / Q000209:etiology / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000175:diagnosis*; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D010290:Parents; D017060:Patient Satisfaction; D011187:Posture; D013129:Spinal Puncture / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*