Bed rest is associated with more post-dural puncture headache

SOURCE
Arevalo-Rodriguez I, Ciapponi A, Roqué I, et al. (2016). Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev 3:CD009199

CONTEXT
Post-dural puncture headache (PDPH) complicates up to 30% of lumbar punctures (LP). Bed rest and supplementary fluids administration are common preventative practices after a LP.

CLINICAL QUESTION
Does bed rest and/or additional fluids administration decrease the risk of PDPH following LP?

BOTTOM LINE
Bed rest (4 to 24h) increases the incidence of PDPH and any headache after LP compared to immediate mobilization (moderate level of evidence). Various head postures or prone body position have no beneficial effect. Supplementary fluids administration has no benefit on the development of PDPH (low level of evidence).

CAVEAT
A sub-analysis including only studies with the lowest risk of bias confirmed the lack of benefit of bed rest following LP. Because of the various types of hydration methods used (oral, intra-venous, volume of hydration) and the small number of included studies, this meta-analysis cannot make definitive conclusions with respect to the administration of supplementary fluids for the prevention of PDPH.

AUTHORS INFORMATION
Sébastien BEROUD
Hospices civils de Lyon, CHU Lyon-Sud,
Lyon, France
sebastien.beroud@chu-lyon.fr

Yannick AUFFRET
Centre Hospitalier Régional Universitaire de Brest
Brest, France
y.auffret@ch-cornouaille.fr

Kirk MAGEE
Dalhousie University –QEII Health Science Centre
Nova Scotia, Canada
kirk.magee@dal.ca