Posture and fluids for preventing post-dural puncture headache

Sudlow CLM, Warlow CP

Published Online:

September 8, 2010

Routine bed rest after dural puncture does not prevent the headache that may follow this procedure, but any role for fluid supplements remains unclear. Dural (usually lumbar) puncture involves passing a needle into the fluid-filled space around the spinal cord and nerve roots. This common procedure is used to obtain spinal fluid for laboratory tests or to give a spinal anaesthetic. To prevent the headache that can result from leakage of fluid though the defect created by the needle, patients may be advised to lie flat for several hours, or receive supplementary fluids afterwards. Randomised trials showed no evidence of benefit from bed rest. Too few patients have been randomised in relevant trials to allow a reliable assessment of the effects of fluid supplements.

Abstract (click to read)

Background:

Potentially disabling postural headache occurs after dural puncture in 1-70% of patients. It has been suggested that such headaches may be less common if patients routinely have a period of bed rest or receive supplementary fluids after the procedure.

Objectives:

To assess the effects on post dural puncture headache of a period of bed rest versus early mobilisation, of different positions during a period of bed rest, and of administering supplementary fluids after the procedure.

Search strategy:

We searched the Cochrane Controlled Trials Register (Cochrane Library, Issue 4, 2000), MEDLINE (January 1994-December 1998), and EMBASE (January 1980-December 1998). We also searched the reference lists of articles identified electronically, and contacted trial authors for information about other potentially relevant studies. Date of the most recent search: December 2000.

Selection criteria:

We sought randomised, unconfounded trials, among all types of patients, that compared the effects on post-dural puncture headache of: bed rest versus early mobilisation; head-down tilt versus horizontal or prone versus supine positions during bed rest; or the administration of supplementary fluids versus control.

Data collection and analysis:

One reviewer extracted data from the reports of all trials considered eligible for inclusion. The authors of included studies were invited to check the information extracted and provide any details that were unavailable in the published reports. Intention-to-treat analyses were performed.

Main results:

Eleven trials among 1723 patients compared either bed rest with immediate mobilisation or a longer versus a shorter period of bed rest. There was a non-significant relative increase in the odds of the primary outcome of postural headache among patients allocated more rather than less bed rest (196/639 [31%] bed rest versus 169/615 [27%] early mobilisation; odds ratio [OR] 1.21; 95% confidence interval [CI] 0.94 to 1.55). Analyses confined to the methodologically most rigorous trials gave similar results. Only two trials among 126 patients compared different positions during bed rest. No statistically significant differences were found, but small numbers made the comparisons imprecise. One trial among 100 patients assessed fluid supplementation. Again, the numbers of patients and outcome events were small, and indicated the possibility of both reduced and increased postural headache with additional fluids.

Authors' conclusions:

There is no good evidence from randomised trials to suggest that routine bed rest after dural puncture is beneficial. The role of fluid supplementation in the prevention of post-dural puncture headache remains uncertain.

This record should be cited as:

Sudlow CLM, Warlow CP. Posture and fluids for preventing post-dural puncture headache. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD001790. DOI: 10.1002/14651858.CD001790

Assessed as up to date:

February 27, 2002

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Primary Review Group:

Pain, Palliative and Supportive Care Group

Health topics:

Neurology > Headache & migraine > Prevention

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Posture and fluids for preventing post-dural puncture headache

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