Computer-modified paramedian approach technique reduces failures and alleviates pain in lumbar puncture: a prospective comparative study

Yuan-Dong Zhuang; Hai-Shu Xie; Jing Chen; Guo-Hua Wu; Jian-Feng Wu; Chun-Mei Chen

doi:10.3389/fmed.2023.1293689

Computer-modified paramedian approach technique reduces failures and alleviates pain in lumbar puncture: a prospective comparative study

Front Med (Lausanne). 2024 Jan 22:10:1293689. doi: 10.3389/fmed.2023.1293689. eCollection 2023.

Authors

Yuan-Dong Zhuang^#¹, Hai-Shu Xie^#¹, Jing Chen^#¹, Guo-Hua Wu², Jian-Feng Wu^{1

3}, Chun-Mei Chen^{1

3}

Affiliations

¹ Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China.
² Department of Anesthesiology, Fujian Medical University Union Hospital, Fujian Institute of Neurosurgery, Fuzhou, Fujian, China.
³ Department of Neurosurgery, Pingtan Comprehensive Experimentation Area Hospital, Pingtan, Fujian, China.

^# Contributed equally.

Abstract

Background: The conventional midline approach for lumbar puncture (MAT-LP) has a relatively low success rate of 70%. The paramedian approach can increase the effective puncture area and success rate but lacks standardized guidelines. This study evaluated a computer-modified paramedian approach technique (CMPAT) to optimize lumbar puncture using computational techniques.

Methods: In this prospective study, 120 patients underwent CMPAT-LP (n = 60) or MAT-LP (n = 60). Puncture failure was defined after 6 attempts. Failure rate, number of attempts, pain score, and complications were compared. Subgroup analysis was conducted for age (≥ 50 years).

Results: No significant demographic differences existed between groups. Failure rates were 3.3% for CMPAT vs. 13.3% for MAT. Puncture attempts averaged 2.0 vs. 3.5 and pain scores were 2.7 vs. 4.1 for CMPAT and MAT, respectively. All outcomes were significantly improved with CMPAT, especially in elderly patients. No significant difference in complications was observed.

Conclusion: Compared to MAT, CMPAT-LP demonstrated lower failure rates, fewer puncture attempts, and less pain, without compromising safety. CMPAT may be superior and should be more widely implemented in clinical practice.

Keywords: complications; computer-modified paramedian approach technique; failure rate; lumbar puncture; midline approach technique; pain; puncture attempts.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by Joint Funds for the Innovation of Science and Technology, Fujian Province (2021Y9061 to Y-DZ), Fujian Provincial Science and Technology Department Social Development Guidance (Key) Project (2020Y0034 to Y-DZ), and United Fujian Provincial Health and Education Project (2019-WJ-08 to C-MC). The funders played important roles in the data collection, analysis, interpretation of data, the writing of the report, and the decision to submit the paper for publication.