EVALUATION OF EFFICACY OF VALSALVA FOR ATTENUATING LUMBAR PUNCTURE PAIN

Aims and objectives:

 Primary objective: To evaluate the efficacy of valsalva procedure in attenuating the lumber puncture pain

 Secondary objective:  To evaluate the efficacy of valsalva procedure on CSF flow

 Methodology: Patients will be randomized with the help of a computer-generated table of random numbers into 3 groups of 30 each. Group I (Control): acted as control and did not perform valsalva nor blew through a open tube; group II (Distraction): patients were asked to blow through a rubber tube not connected to sphygmomanometer; Group III (Valsalva):  patients were asked to blow into a rubber tubing connected to sphygmomanometer and raise the mercury column up to 30 mmHg for a period of at least 20 sec. During the valsalva spinal puncture would be performed with a 26 G spinal needle.

 Exclusion: obese patients, history of previous spinal surgery, patient’s refusal for spinal, patients requiring > 1 attempt for successful spinal or change of inter vertebral space

 Risks associated with the procedure are none as in ASA 1 and 2 patients; however, valsalva procedure has been reported to attenuate pain in animal studies and more so in humans for minimizing venous cannulation pain in adults and paediatric patients. We therefore wish to evaluate its efficacy in attenuating the lumber puncture pain.