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Position for lumbar punctures.

To the Editor.—
 In "A Controlled Clinical Trial of Local Anesthesia for Lumbar Punctures in Newborns"1 Porter et al reported on their attempt to decrease lumbar puncture-induced physiologic instability by using lidocaine. While the cardiorespiratory measures of physiologic instability were not affected by local anesthesia, they were influenced significantly and adversely by the preparatory procedure (ie, being held flexed in the fetal position). As pointed out by the authors, the position chosen for the procedure, which included knees to chest plus flexion of head and neck has been shown to induce more adverse physiologic responses than either the sitting or the modified lateral (neck not flexed) position.2,3