Medication Summary
The amount of lidocaine provided in most kits is often inadequate. The authors recommend supplementing the kit with a 10-mL syringe and a bottle of 1% lidocaine. Make sure not to exceed the maximal recommend dose of 4.5 mg/kg of lidocaine. A smaller needle (27 gauge, 1.25 in.) may be used for infiltration. Smaller needles are shown to be associated with less pain during local anesthesia.
Local Anesthetics
Class Summary
Local anesthetic agents are used to increase patient comfort during the procedure.
Lidocaine
Lidocaine is an amide local anesthetic used in a 1-2% concentration. This agent inhibits depolarization of type C sensory neurons by blocking sodium channels. Epinephrine prolongs the effect and enhances hemostasis (maximum epinephrine dose, 4.5-7 mg/kg).
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Lumbar puncture disposable tray. Image courtesy of Gil Z Shlamovitz, MD.
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Lumbar puncture lateral recumbent position. Image courtesy of Gil Z Shlamovitz, MD.
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Lumbar puncture sitting position. Image courtesy of Gil Z Shlamovitz, MD.
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L3-L4 interspace palpation. Image courtesy of Gil Z Shlamovitz, MD.
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CSF collection tubes. Image courtesy of Gil Z Shlamovitz, MD.
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Skin preparation. Video courtesy of Gil Z Shlamovitz, MD.
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Drape application. Video courtesy of Gil Z Shlamovitz, MD.
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Local anesthesia. Video courtesy of Gil Z Shlamovitz, MD.
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Spinal needle insertion. Video courtesy of Gil Z Shlamovitz, MD.
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Spinal needle removal. Video courtesy of Gil Z Shlamovitz, MD.
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Opening pressure measurement. Video courtesy of Gil Z Shlamovitz, MD.