Analgesia for lumbar puncture in infants and children

Question As a family physician who works in the local community emergency department, my skills include performing lumbar puncture in young children and infants. I hear conflicting recommendations in regard to provision of analgesia during lumbar puncture in these patients. Does local analgesia affect the success rate of the procedure? What is the best practice for analgesia in young children and infants? Answer Lumbar puncture is one of the most commonly encountered painful procedures in pediatric medicine; it is imperative for timely diagnosis of central nervous system infections in febrile young infants. For many years it has been documented that health care providers provide suboptimal analgesia, despite the understanding that this is a painful procedure for infants and children of all ages. Using a lidocaine and prilocaine combination or a 1% lidocaine infiltration (or both) is recommended and has been associated with improved outcomes during the procedure.