Efficacy of ultrasound guidance for lumbar punctures: a systematic review and meta-analysis of randomised controlled trials

Abstract

Ultrasound guidance has been reported to facilitate the performance of lumbar punctures (LPs). However, the use of ultrasound guidance has not yet received consistent conclusions. We performed a systematic review and meta-analysis to determine the efficacy of ultrasound-guided LPs. PubMed, Embase and the Cochrane Library were searched for randomised controlled trials comparing ultrasound guidance with traditional palpation for LPs in adults. The primary outcome was risk of failed procedures. A random-effects Mantel-Haenzsel model or random-effects inverse variance model was used to calculate relative risks (RRs) or standardised mean differences (SMDs) with 95% CIs. Twenty-eight trials (N=2813) met the inclusion criteria. Ultrasound-guided LPs were associated with a reduced risk of failed procedures (RR=0.58, 95% CI 0.39 to 0.85, p=0.005). No significant heterogeneity was detected (I2=27%) among these trials. It further decreased first attempt to failure (RR=0.43, 95% CI 0.30 to 0.62, p<0.00001), mean attempts to success (SMD=−0.61, 95% CI −0.80 to −0.43, p=0.00001) and incidences of complications of headache and backache (RR=0.63, 95% CI 0.46 to 0.85, p=0.003). Ultrasound guidance is an effective technique for LPs in adults.

In‐plane guided upper arm arteriovenous fistula cannulation with color ultrasound

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Embolisation of iatrogenic lumbar artery bleed causing psoas haematoma following elective lumbar puncture

“…Measures to minimise the risk of complications and make lumbar puncture safer should be incorporated into guidelines, including methods to ensure the correct position of L3/L4 or L4/L5 is found, use of atraumatic spinal needles, and performing the procedure under ultrasound guidance 16 17…”

Point-of-Care Ultrasound: A Multimodal Tool for the Management of Sepsis in the Emergency Department

“…It is estimated that in the ED, approximately 30% of the patients have difficult anatomy with less palpable landmarks and in about 15% of them, the landmark-based approach might be traumatic. POCUS identifies the ideal lumbar spine level and reduces the number of needle insertions and redirections, the time to successful procedure, the risk of traumatic taps and the incidence of complications, such as headache and backache [ 89 , 90 , 91 ].…”