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Efficacy of ultrasound guidance for lumbar punctures: a systematic review and meta-analysis of randomised controlled trials
  1. LiPei Shu,
  2. Jiao Huang,
  3. Jing Chen Liu
  1. Department of Anesthesiology, First Affiliated Hospital of Guangxi Medical University, Nannig, China
  1. Correspondence to Jing Chen Liu, Department of Anesthesiology, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nannig 530021, China; jingchenl{at}


Ultrasound guidance has been reported to facilitate the performance of lumbar punctures (LPs). However, the use of ultrasound guidance has not yet received consistent conclusions. We performed a systematic review and meta-analysis to determine the efficacy of ultrasound-guided LPs. PubMed, Embase and the Cochrane Library were searched for randomised controlled trials comparing ultrasound guidance with traditional palpation for LPs in adults. The primary outcome was risk of failed procedures. A random-effects Mantel-Haenzsel model or random-effects inverse variance model was used to calculate relative risks (RRs) or standardised mean differences (SMDs) with 95% CIs. Twenty-eight trials (N=2813) met the inclusion criteria. Ultrasound-guided LPs were associated with a reduced risk of failed procedures (RR=0.58, 95% CI 0.39 to 0.85, p=0.005). No significant heterogeneity was detected (I2=27%) among these trials. It further decreased first attempt to failure (RR=0.43, 95% CI 0.30 to 0.62, p<0.00001), mean attempts to success (SMD=−0.61, 95% CI −0.80 to −0.43, p=0.00001) and incidences of complications of headache and backache (RR=0.63, 95% CI 0.46 to 0.85, p=0.003). Ultrasound guidance is an effective technique for LPs in adults.

  • Anaesthetics
  • Adult anaesthesia
  • Basic sciences
  • Anatomy
  • Education & training (see Medical Education & Training)
  • Neurology
  • Adult neurology
  • Obstetrics
  • Ultrasonography

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  • LPS and JH contributed equally to this work

  • Contributors LPS and JH participated in the entire procedure including the design and coordination of the study, the literature search, data extraction, performed the statistical analysis, drafted the manuscript and revised submitted the manuscript. All authors read and approved the final manuscript. JCL made substantial contributions to the conception and design of the work; revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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