Step 7: Cutaneous anesthesia

Using the provided 25 gauge needle, begin to freeze the skin at the site marked for lumbar puncture. Place the needle two-thirds of the way towards the chosen lower spinous process. Start your injection of lidocaine just prior to insertion of the needle into the skin and administer the lidocaine slowly to minimize the pain of the injection. Raise a skin bleb. Then position the needle parallel to the bed and aim it towards the umbilicus. Advance the needle while administering the lidocaine. Continue this until the needle is completely inserted using about half of the provided lidocaine.