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Capstone

A randomized, prospective, cross-over study to determine if there is no difference in opening pressure in cerebrospinal fluid in patients placed in a flexed lateral recumbent vs uprigbt sitting position during lumbar puncture.

1 August 2002

Abstract

Objective: Lumbar puncture is a procedure that at times can be difficult where it may take multiple attempts to obtain a fluid sample and an opening pressure. While it is recommended that the patient be placed in the lateral recumbent position, many physicians find that placing patients in an upright or sitting position provides an easier access. The theoretical concern is that obtaining an opening pressure in the sitting position may be altered. The purpose of this investigation is to determine if there is no difference in opening pressure in cerebrospinal fluid in patients placed in a flexed lateral position vs. upright sitting position during lumbar puncture.

Methods: 20 consenting patients were entered into a prospective, crossover study who required a diagnostic lumbar puncture. Opening pressure was measured in both recumbent and sitting positions. Starting positions were previously randomized. Means, medians, and ranges were calculated and analyzed.

Results: Mean opening pressure in the sitting position ranged from 16-53 cm H20. The mean was 32.64 cm H20. Mean opening pressure in the recumbent position ranged from 11-44 cm H20. The mean was 23.0 cm H20.

Conclusions: The findings of this study conclude that there is a difference between the sitting and the recumbent positions The sitting position may be used for lumbar puncture, however, if an opening pressure is needed, the lateral recumbent position would be the preferred position to use.


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