Pattern of pain management during lumbar puncture in children.
BACKGROUND
Although studies have shown that children have similar physiological pain responses as adults, children often receive less pain medication compared with adults with similar painful conditions. The lumbar puncture is a painful procedure that historically has been commonly performed without local anesthesia, especially in young infants.


OBJECTIVE
The aim of the study was to determine what type of pain management, if any, pediatric patients received during lumbar puncture and whether its use varied by patient age.


METHODS
We performed a retrospective review of patients who had cerebrospinal fluid cultures obtained via lumbar puncture during 2003 at a large urban children's hospital. Eligible cases were reviewed for demographic data, hospital patient care area, and type of pain management used for the procedure.


RESULTS
Of the 353 children who had lumbar punctures performed, 84 (23.8%) received some form of pain management before their lumbar puncture. Sixty (17.0%) received local anesthesia, 43 (12.2%) received sedation, and 19 (5.4%) of these received both local anesthesia and sedation. Younger patients received pain management less frequently (P < 0.001): 16 (6.5%) of 246 neonates (0-2 months), 4 (14.3%) of 28 infants (3-18 months), 9 (60%) of 15 preschoolers (19-59 months), and 55 (85.9%) of 64 older children (60 months to 21 years). Among infants, patients treated in the emergency department received pain management more often than those treated in the nursery (13/103 [12.6%] vs 1/117 [0.9%]; P = 0.001).


CONCLUSIONS
Despite advances in the awareness and attentiveness given to pain and pain management in the pediatric population, children are still not receiving satisfactory pain management for lumbar punctures.
Fein
Daniel
D
Department of Pediatrics, Children's Hospital at Montefiore, Rosenthal 4, 111 E 210th St, Bronx, NY 10467, USA. danfein@gmail.com
Avner
Jeffrey R
JR
Khine
Hnin
H
D000293:Adolescent; D000772:Anesthesia, Local / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D059408:Pain Management; D010147:Pain Measurement; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult