Pain management strategies for lumbar puncture in infants ≤6 months: A systematic review and meta-analysis
Bibliographic record
Abstract
Background: Lumbar puncture (LP) is a painful procedure performed in infants. Both national and international organizations recommend the use of local anesthetics for LP pain management. However, recommendations are not based on systematic review of the literature. The primary objective of this systematic review and meta-analysis was to synthesize the literature on local anesthetics and opioids for pain management in infants undergoing LP. Methods: Databases were searched for randomized trials from inception to March 2024. The literature search was updated in June 2025 and no additional eligible articles were identified for inclusion. Title and abstract screening, full-text screening and data extraction were performed in duplicate. Risk of bias was assessed using Cochrane's risk of bias (RoB) 2.0 tool. The critically important outcome was pain measured using validated tools including unidimensional behaviour and multidimensional (comprising combinations of contextual, behavioural and/or physiological components) tools. Secondary outcomes included procedure success and adverse events. Pooled effect estimates were standardized mean difference (SMD) and relative risk (RR) with 95% confidence intervals (CI) using random effects models. A GRADE assessment of the overall certainty of the evidence for each outcome was completed. Results: = 0, n = 215). Fentanyl was effective in reducing acute pain compared to placebo (SMD -1.93 [95% CI -2.64, -1.21]). Across all comparisons, there was no difference in procedure success and number of attempts in studies including local anesthetics. No serious adverse events were attributed to local anesthetics or opioids. There was moderate to low certainty of evidence for all critical and important outcomes. Discussion: Both local anesthetics and opioids are effective in reducing pain associated with LP based on limited evidence and can be incorporated in clinical practice. Future studies should evaluate the effectiveness and safety of combined analgesia and alternative routes of administration for opioids.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.028 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.040 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".