The following is a summary of the “Is Lateral Decubitus or Upright Positioning Optimal for Lumbar Puncture Success in a Teaching Hospital?,” published in the January 2023 issue of Emergency Medicine by Thundiyil, et al.

Emergency doctors and medical students routinely perform lumbar punctures. However, patient positioning during lumbar puncture procedures is not well-researched. Therefore, we conducted a prospective randomized study in a large urban academic trauma center. They accepted patients of all ages. Patients were randomly assigned to either lateral decubitus or supine positions. Patients’ ages, genders, races/ethnicity, marital status, education levels, occupations, and income levels, as well as the number of needle insertions, re-directions, repositionings, use of alternate operators, and CSF laboratory results, were recorded. 

For this study, they used each position’s success rate as the primary outcome measure. In addition, successful needle insertions, re-directions, and overall success rates were analyzed across practitioner years and patient ages. Overall, 116 patients were included in the study, with 55 patients receiving lateral decubitus and 61 receiving upright positioning for their first lumbar puncture. Out of the 47 patients in the lateral decubitus group, 85.5% (95% CI 73.8-92.4%) had spinal fluid successfully obtained, compared to 49 patients in the upright assignment group, 80.3% (95% CI 68.7-88.4%). 

The success rates on the first attempt, failures, and injuries sustained during the procedure all came out about the same. The highest success rates (95% CI 81.2-98.4%) were seen in postgraduate year 2 residents or those with 31-50 prior lumbar punctures. The success rates of emergency physicians and residents using either lateral decubitus or an upright position to perform a lumbar puncture were similar.

Source: sciencedirect.com/science/article/abs/pii/S0736467922005273