Effects of Local Skin Anaesthesia on Pain During Lumbar Puncture

Background: Although spinal anaesthesia has a more favourable risk-profile, patients prefer surgery under general anaesthesia. Besides fear of severe but rare neurological complications, reasons for rejection are fear of backache or anticipated pain during puncture. Providing local anaesthesia before lumbar puncture is not a standard procedure. The aim of this randomized clinical trial was to evaluate the efficacy in pain reduction and the effect on patient satisfaction when using different local anaesthetic treatments before puncture.

Methods: 83 patients receiving spinal anaesthesia were randomly allocated to three subgroups: group I (control) did not receive any local anaesthetic pre-treatment of the skin, group II (EMLA) received EMLA patch and group III (Prilocaine) received local skin infiltration using 2 ml of Prilocaine prior to lumbar puncture. Pain during puncture, duration of procedure, comparison of expected versus actual pain as well as future decision for or against spinal anaesthesia was assessed.

Results: Pain during puncture was significantly reduced in the EMLA and Prilocaine groups as compared to patients in the control group. No significant differences between the EMLA and Prilocaine groups were detected, though pain scores were slightly lower in the EMLA-group. Duration of procedure was significantly longer in the Prilocaine-group as compared to the EMLA-group. Although pain was significantly higher in the control group, there was no significant difference between the groups regarding future acceptance of spinal anaesthesia.

Conclusion: Irrespective of the type (EMLA or Prilocaine), the use of local anaesthetic pre-treatment of the skin was found to significantly reduce pain during puncture. Our data supports the use of local anaesthesia prior to spinal puncture in daily routine. There was a trend towards better pain control in the EMLA-group; however, the actual pain in all groups was not clinically relevant in terms of decision for or against future spinal anaesthesia.

Author(s): Christina Massoth, Susanne Weidlich, Daniel M Pöpping, Simone Gurlit, Michael Möllmann and Manuel Wenk

Abstract | Full-Text | PDF

Share This Article