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Master Thesis

Effect of position during lumbar puncture on children's pain experience : a prospective pilot study

Abstract : Background :
An essential part of acute leukemia treatment is central nervous system prophylaxix mostly performed by intrathecal chemotherapy. Although lumbar puncture is highly safe, this invasive procedure may cause a lot of pain and anxiety for the patient and even their parents’. Two positions are possible to perform LP: sitting upright (SU) or lateral recumbent (LR) which seems closer than fetal position and could be more suitable for a calm and relax child. Therefore the current study aimed to evaluate in a randomized control trial the impact of patient’s position (LR versus SU) on pain and anxiety during lumbar puncture.
Methods :
We included children between 2 and 18 years old during 2 years from onco-hematology department in Nice. They had to require at least two LP for therapeutic purpose and benefit local analgesia by mixing lidocaine / prilocaïne and inhalation of nitrous oxide. Each Child had SU LP and LR LP. Order was defined by randomization. Primary outcome was to measure the maximum LP-induced pain with self-reported pain (Analog Visual Scale AVS) in children over 6 years old and hetero-evaluation (FLACC scale) in children 2-6 years old. The key secondary endpoints were the maximum LP-induced anxiety score evaluated by an AVS in children over 6 years old, parents, nurses and physicians.
Results :
38 patients were assessed for eligibility between September 1st 2015 and august 31st 2017. 28 patients (11 girls) were randomized (16 under 6 years old: group 1, and 12 were 6-18 years old: group 2). 13 children had primary LR LP. In group 1, means of FLACC were 2.8/10 ± 3.0 (median=1) at first time and 1.5 ± 1.7 (median=1) at second time. In group 2, means of EVA were 2.2 ± 2.2 (median=1.5) at first time and 3.2 ± 2.8 (median=3) at second time. Position didn’t influence anxiety level of children, parents, nurses or physicians. In paired analyses, we didn’t find any difference on pain in Group 1 or Group 2 between first and second LP: z=1.152; p<0.249 and z=-0.765 p<0.444, respectively.
Conclusion :
Even if LP doesn’t seem to be very painful, its repetition can generate anxiety, stress and increase pain. Regrettably we didn’t be able to demonstrate whether LR position could generate less pain and anxiety than SU position for LP in children. More studies, with higher recruitment could help to show difference between LR and SU position on pain in children. 
Document type :
Master Thesis
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  • HAL Id : dumas-01703148, version 1

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Philippine Pardes Chavanes. Effect of position during lumbar puncture on children's pain experience : a prospective pilot study. Human health and pathology. 2017. ⟨dumas-01703148⟩

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