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A positioning pillow to improve lumbar puncture success rate in paediatric haematology-oncology patients: a randomized controlled trial.

Marec-Bérard P, Bissery A, Kebaïli K, Schell M, Aubert F, Gaillard S, Rabilloud M, Kassaï B, Cornu C - BMC Cancer (2009)

Bottom Line: The LP pillow tended to increase the success rate of LPs (67% vs. 57%, p = 0.23), and decreased the post-LP syndromes (15% vs. 24%, p = 0.17) but the differences were not statistically significant.In children over 6-year of age (n = 72), the rate of success was significantly higher in the pillow group (58.5% vs. 41.5%, p = 0.031), with a tendency to feel less pain (median VAS 25 vs. 15 mm, p = 0.39) and being more satisfied (84.4% vs. 75.0%, p = 0.34).This study results also suggest a benefit in the sub group of children over 6-year of age; this result needs confirmation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Service d'Oncologie Pédiatrique, Institut d'Hémato-Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France. marec@lyon.fnclcc.fr

ABSTRACT

Background: Lumbar punctures (LPs) are common in children with cancer. Although pain management during the lumbar puncture has been well standardized, dealing with stress and anxiety is not well addressed yet. Our objective was to evaluate the potential improvement of the LP success rate using a positioning pillow, to ensure maximum lumbar flexion, and allow paravertebral muscles to relax, in children who are awake, with either conscious sedation or no sedation.

Methods: Children aged 2-18 years undergoing LP were randomly assigned to a positioning pillow or no intervention. The primary outcome was the rate of success, i.e. achieving the LP (sampling or injection) at the first attempt, without bleeding (RBC < 50/mm3). The secondary outcomes included: the child's pain, assessed by a self-administered visual analogical scales (VAS) for children over 6 years of age; the parents' and caregivers' perception of the child's pain; the satisfaction of the children, the parents, the caregivers and the physician. The child's cooperation and the occurrence of post-LP syndrome were also evaluated.

Results: 124 children (62 in each group) were included. The LP pillow tended to increase the success rate of LPs (67% vs. 57%, p = 0.23), and decreased the post-LP syndromes (15% vs. 24%, p = 0.17) but the differences were not statistically significant. In children over 6-year of age (n = 72), the rate of success was significantly higher in the pillow group (58.5% vs. 41.5%, p = 0.031), with a tendency to feel less pain (median VAS 25 vs. 15 mm, p = 0.39) and being more satisfied (84.4% vs. 75.0%, p = 0.34).

Conclusion: Overall results do not demonstrate a benefit in using this pillow for lumbar punctures. This study results also suggest a benefit in the sub group of children over 6-year of age; this result needs confirmation.

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Related in: MedlinePlus

flow diagram of the progress through the study.
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Related In: Results  -  Collection

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Figure 2: flow diagram of the progress through the study.

Mentions: Between July 2004 and September 2006, 124 children, 62 in the pillow group and control group were included. Twenty four children were included in centre 1 (paediatric oncology service), and 100 children in centre 2 (paediatric haematology), in the paediatric hemato-oncology Institute, Lyon, France. Because of technical problems, cerebrospinal fluid samples could not be analyzed in three patients (two in the control group, one in the pillow group). One participant in the control group was given a pillow (protocol deviation) (Figure 2)


A positioning pillow to improve lumbar puncture success rate in paediatric haematology-oncology patients: a randomized controlled trial.

Marec-Bérard P, Bissery A, Kebaïli K, Schell M, Aubert F, Gaillard S, Rabilloud M, Kassaï B, Cornu C - BMC Cancer (2009)

flow diagram of the progress through the study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2651181&req=5

Figure 2: flow diagram of the progress through the study.
Mentions: Between July 2004 and September 2006, 124 children, 62 in the pillow group and control group were included. Twenty four children were included in centre 1 (paediatric oncology service), and 100 children in centre 2 (paediatric haematology), in the paediatric hemato-oncology Institute, Lyon, France. Because of technical problems, cerebrospinal fluid samples could not be analyzed in three patients (two in the control group, one in the pillow group). One participant in the control group was given a pillow (protocol deviation) (Figure 2)

Bottom Line: The LP pillow tended to increase the success rate of LPs (67% vs. 57%, p = 0.23), and decreased the post-LP syndromes (15% vs. 24%, p = 0.17) but the differences were not statistically significant.In children over 6-year of age (n = 72), the rate of success was significantly higher in the pillow group (58.5% vs. 41.5%, p = 0.031), with a tendency to feel less pain (median VAS 25 vs. 15 mm, p = 0.39) and being more satisfied (84.4% vs. 75.0%, p = 0.34).This study results also suggest a benefit in the sub group of children over 6-year of age; this result needs confirmation.

View Article: PubMed Central - HTML - PubMed

Affiliation: Service d'Oncologie Pédiatrique, Institut d'Hémato-Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France. marec@lyon.fnclcc.fr

ABSTRACT

Background: Lumbar punctures (LPs) are common in children with cancer. Although pain management during the lumbar puncture has been well standardized, dealing with stress and anxiety is not well addressed yet. Our objective was to evaluate the potential improvement of the LP success rate using a positioning pillow, to ensure maximum lumbar flexion, and allow paravertebral muscles to relax, in children who are awake, with either conscious sedation or no sedation.

Methods: Children aged 2-18 years undergoing LP were randomly assigned to a positioning pillow or no intervention. The primary outcome was the rate of success, i.e. achieving the LP (sampling or injection) at the first attempt, without bleeding (RBC < 50/mm3). The secondary outcomes included: the child's pain, assessed by a self-administered visual analogical scales (VAS) for children over 6 years of age; the parents' and caregivers' perception of the child's pain; the satisfaction of the children, the parents, the caregivers and the physician. The child's cooperation and the occurrence of post-LP syndrome were also evaluated.

Results: 124 children (62 in each group) were included. The LP pillow tended to increase the success rate of LPs (67% vs. 57%, p = 0.23), and decreased the post-LP syndromes (15% vs. 24%, p = 0.17) but the differences were not statistically significant. In children over 6-year of age (n = 72), the rate of success was significantly higher in the pillow group (58.5% vs. 41.5%, p = 0.031), with a tendency to feel less pain (median VAS 25 vs. 15 mm, p = 0.39) and being more satisfied (84.4% vs. 75.0%, p = 0.34).

Conclusion: Overall results do not demonstrate a benefit in using this pillow for lumbar punctures. This study results also suggest a benefit in the sub group of children over 6-year of age; this result needs confirmation.

Show MeSH
Related in: MedlinePlus