The effects of 45 degree head up tilt on the lumbar puncture success rate in children undergoing spinal anesthesia

Background: There are few studies for procedural techniques of lumbar puncture (LP) for spinal anesthesia in children. There are no controlled studies on the effect of patient positioning. We designed this prospective, randomized study to compare the success rates of LP of the lateral decubitus and lateral decubitus position with a 45 degree head up tilt in children undergoing spinal anesthesia. Methods: Study was conducted in 180 children aged between one month to twelve years. The LP was performed under general anesthesia using sevoflurane with a 26-gauge, atraumatic needle either in the standard lateral decubitus, knee-chest position (group I, n = 90) or lateral decubitus, knee-chest position with a 45 degree head up tilt (group II, n = 90). The free flow of clear cerebrospinal fluid (CSF) at first attempt was considered to evidence a successful LP. Results: The two groups were similar in age and weight. Total LP success rate was higher in group II than in group I (P < 0.05). When the significance between the groups was evaluated according to age, the increase in LP success rate was significant in children aged < 12 months of age but not significant in children older than 12 months of age. Conclusions: Because of higher success rate, lateral decubitus, knee-chest position with 45 degree head up tilt may be the preferred position for spinal anesthesia in infants.