How can bedside grading method predict difficult lumbar puncture?

The clinical uses of spinal anesthesia (SA) are many. The use of this technique is prevalent among patients who are having infra-umbilical procedures with a predetermined duration. The procedure in question is generally considered to be safe and offers many benefits. However, in cases when a challenging lumbar puncture (LP) is encountered, it might result in patient pain and elevate the occurrence of postdural puncture headache, spinal hemorrhage, and nerve injury. Therefore, it is important to have a scoring system in place that assesses the likelihood of encountering challenges throughout the execution of linear programming (LP). The research assessed the patient factors that might be indicative of challenging lumbar puncture procedures, so enabling the consideration of alternative approaches.

The study included a sample of 200 patients with ASA physical status I-II who were slated to have elective infra-umbilical surgical operations under spinal anesthesia. During the preanesthetic evaluation, the difficulty score was determined by assessing five variables: age, abdominal circumference, spinal deformity (measured as axial trunk rotation (ATR) value), anatomical spine (evaluated using the spinous process landmark grading system (SLGS)), and patient position. Each variable was assigned a score ranging from 0 to 3, resulting in a total score ranging from 0 to 15. The amount of difficulty associated with LP procedures was assessed by an independent investigator with expertise in the field, taking into consideration the overall number of tries made and the specific spinal levels involved. This assessment categorized the difficulty level as either easy, moderate, or severe. The scores acquired during the preanesthetic examination and the data gathered subsequent to doing a lumbar puncture were subjected to multivariate analysis, and the resulting P value was recorded.