Pattern of pain management during lumbar puncture in children

Background: Although studies have shown that children have similar physiological pain responses as adults, children often receive less pain medication compared with adults with similar painful conditions. The lumbar puncture is a painful procedure that historically has been commonly performed without local anesthesia, especially in young infants. Objective: The aim of the study was to determine what type of pain management, if any, pediatric patients received during lumbar puncture and whether its use varied by patient age. Methods: We performed a retrospective review of patients who had cerebrospinal fluid cultures obtained via lumbar puncture during 2003 at a large urban children's hospital. Eligible cases were reviewed for demographic data, hospital patient care area, and type of pain management used for the procedure. Results: Of the 353 children who had lumbar punctures performed, 84 (23.8%) received some form of pain management before their lumbar puncture. Sixty (17.0%) received local anesthesia, 43 (12.2%) received sedation, and 19 (5.4%) of these received both local anesthesia and sedation. Younger patients received pain management less frequently (P < 0.001): 16 (6.5%) of 246 neonates (0-2 months), 4 (14.3%) of 28 infants (3-18 months), 9 (60%) of 15 preschoolers (19-59 months), and 55 (85.9%) of 64 older children (60 months to 21 years). Among infants, patients treated in the emergency department received pain management more often than those treated in the nursery (13/103 [12.6%] vs 1/117 [0.9%]; P = 0.001). Conclusions: Despite advances in the awareness and attentiveness given to pain and pain management in the pediatric population, children are still not receiving satisfactory pain management for lumbar punctures.