Possible Decreased Post Lumbar Puncture Headache when using Procedural Sedation and Analgesia for Lumbar Puncture in the Pediatric Population

Study Objective: In the setting of a pediatric emergency room, Lumbar Puncture (LP) can be painful and stressful for the patient and surroundings. Procedural pain and anxiety relief is an ethical imperative when treating children. Procedural sedation and analgesia (PSA) have become standard practice in pediatric emergency departments worldwide.
The aim of our study was to assess the efficacy of using PSA during LP in reducing the incidence of traumatic LP and post LP parameters in pediatric population in our medical center.

Methods: A retrospective study examined medical files of patients aged 0-18 years which underwent LP. Two cohorts were compared; 2008-2009 period- PSA were not performed as a routine, and 2017-2018 period- during PSA were performed if not contraindicated. Primary variables were extracted: Demographics, LP results (culture, WBC, RBC), hospitalization days, post LP headache and other secondary variables.

Results: 463 medical files were reviewed. No difference was found in the indices of traumatic LP between all age groups, regardless of PSA use. Shorter hospitalization was noted in the age group of 3-10 years PSA group (1.71 days vs.2.92 days without sedation. (p=0.004)) At that age group, a higher prevalence of post LP headache was described in the non-sedated patients: (15/63, vs. 8/65) (p=0.9). There were no notable differences between other study parameters.

Conclusions: PSA may have an important influence on the incidence of post LP headache in pediatric population. It may have several other important roles and thus should be kept in use as part of the routine treatment of pediatric population.