Postdural Puncture Headache Incidence Not Reduced With Bed Rest, Fluid Supplementation

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No evidence was found from randomized clinical trials indicating that routine bed rest or fluid supplementation prevents the onset of postdural puncture headache.
No evidence was found from randomized clinical trials indicating that routine bed rest or fluid supplementation prevents the onset of postdural puncture headache.

Bed rest is not superior to early mobilization or fluid supplementation for reducing the incidence of postdural puncture headache, according to an updated meta-analysis published in the Annals of Emergency Medicine.

Using the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Literatura Latino Americana em Ciências da Saúde (LILACS) databases, investigators reviewed 24 randomized controlled trials that consisted of a total of 2996 participants. Included trials assessed patients who underwent dural puncture and compared interventions aimed to prevent the incidence of postdural puncture headache.

A total of 12 randomized controlled trials demonstrated an increased risk for postdural puncture headache with bed rest vs immediate mobilization (moderate-quality evidence, risk ratio [RR], 1.24; 95% CI, 1.04-1.48). In addition, bed rest was shown to increase the incidence of any headache more than immediate mobilization in 18 trials (moderate-quality evidence, RR, 1.16; 95% CI, 1.02-1.32).

Bed rest was not associated with a decreased incidence of postdural puncture headache after indication-based subgroup analyses that included spinal anesthesia, diagnostic lumbar puncture, and myelography.

In addition, 2 trials at low risk for bias did not demonstrate a reduced risk for postdural puncture headache with a bed-rest approach (RR, 1.18; 95% CI, 0.90-1.54), and 1 trial demonstrated no associative benefit with fluid supplementation (RR, 1.00; 95% CI, 0.59-1.69).

The study was limited to evaluating only early mobilization and fluid supplementation and does not include data on other alternative interventions that may possibly provide a beneficial effect in these patients.

The authors conclude that according to of this updated analysis, neither bed rest nor fluid supplementation appear to decrease the incidence of headache postdural puncture.

Reference

April MD, Long B. Does bed rest or fluid supplementation prevent post-dural puncture headache? [published online January 15, 2018]. Ann Emerg Med. doi: 10.1016/j.annemergmed.2017.12.011

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