[Postspinal headache. Is 24-hour flat bedrest a preventive measure?]. Is early mobilization associated with lower incidence of postspinal headache? A controlled trial in 69 urologic patients. Failure of postural manoeuvres to prevent lumbar puncture headache. Post-lumbar-puncture headache: the significance of body posture. A controlled study of 300 patients. [Bed rest after lumbar puncture is unnecessary and time-consuming]. Bed rest and postlumbar puncture headache. The effectiveness of 24 hours' recumbency in reducing the incidence of postlumbar puncture headache. Posture and post-spinal headache. A controlled trial in 80 obstetric patients. Radiculography: is routine bed rest really necessary? Radiculography with non-ionic contrast medium: routine bed rest is unnecessary. Routine bed rest is unnecessary after cervical myelography. Incidence of side effects following direct puncture cervical myelography. Bed rest versus normal mobility.
Spinal anaesthesia was performed with a 22-gauge needle on 112 consecutive patients above fifty years of age admitted for transurethral surgery. Patients were randomly allocated to either 24 h of recumbency (group A) or ambulation as soon as the spinal had worn off (group B). Postspinal headache was found in 14% of the patients in the recumbency group and in 11% of the patients in the group of early ambulation. There were no differences between the groups regarding incidence, time of onset and duration of postspinal headache. Based on the literature and the present investigation, early ambulation is therefore recommended. Sixty-nine patients who underwent transurethral resection of the prostate under subarachnoid anaesthesia were studied. They were randomly allocated to either an early mobilisation group (group A, 30 patients), or a 24 hour bed rest group (group B, 39 patients). The incidence and severity of postspinal headache were assessed in each patient at 24, 48 and 72 hours. The incidence of headache in group B was significantly higher when compared with group A at 48 and 72 hours postoperatively (p less than 0.025 and p less than 0.01, respectively). The total incidence of headache throughout the 72 hours was also significantly higher in group B (p less than 0.01). Regarding the severity of headache the two groups did not differ significantly. Therefore, bed rest is not recommended as a prophylactic measure for postspinal headache. Diagnostic lumbar puncture was performed on 76 neurological inpatients. They were randomly allocated to one of four bed rest positions for four hours following the procedure (supine and horizontal, prone and horizontal, supine with head-down tilt and prone with head-down tilt) after which they were allowed to get up. There was no substantial or significant difference in the incidence of headache between the four groups. Expectation of headache did not appear to be an important factor in its development. In this single-blind, randomized study of post-lumbar-puncture headache (PPH) in 300 neurologic inpatients the significance of body posture after lumbar puncture (LP) was evaluated. Immediate mobilization was compared with bed rest for 6 h (3 h prone followed by 3 h supine posture). Contrary to the widely held belief, this investigation did not show significant differences between recumbent and ambulant patients as to frequency of PPH in the total material (39% versus 35%) or when men (31% versus 29%) and women (48% versus 41%) were evaluated separately. Headache associated with nausea was significantly more frequent in the recumbent than in the ambulant patients both in the total material (23% versus 13%) and in women (35% versus 16%). Thus, immediate mobilization seems to be preferable after LP. nan A prospective, blind, randomised trial was undertaken to determine if the incidence of postlumbar puncture headache is significantly altered by 24 hours' recumbency. One hundred and two patients were allocated randomly to rest supine in bed for either 4 or 24 hours after spinal anaesthesia for urological or gynaecological surgery. A standardised spinal anaesthetic technique was applied that incorporated the use of a 22-gauge needle. All patients were followed-up prospectively to determine if there was a difference in the incidence of postlumbar puncture headache between the two groups. Five patients (11.6%) who were recumbent for 4 hours developed postlumbar puncture headache, a result which was not statistically significantly different from the seven patients (11.9%) in the other group who complained of postlumbar puncture headache. Eighty obstetric patients receiving subarachnoid anaesthesia for second and third stage procedures, excluding Caesarean section, were studied. They were randomly allocated postpartum to either 24 h bed rest or early (6 h post spinal) mobilization. Patients were followed up at 48 h post-partum and the incidence and severity of post-spinal headache noted. There was a significantly greater incidence of severe spinal headaches in the "bed-rest" group and three patients in this group required blood patch treatment for their headache. Early mobilization is, therefore, the recommended management after spinal anaesthesia for these types of obstetric procedure. After undergoing metrizamide radiculography, 119 patients were randomly allocated to two groups, one group remaining ambulant and the other being kept in bed for 24 h. A member of staff who did not know the category allocation questioned each patient regarding the occurrence of side-effects 24 and 48 h after the procedure. It was found that the incidence and severity of complications was neither increased nor decreased by allowing the patient to remain ambulant. In a prospective study into the occurrence of side-effects, 200 patients who had undergone iopamidol radiculography were randomly allocated into two groups, one being confined to bed for 24 h and the other allowed to be fully ambulant. We found that the incidence of side-effects was not increased by allowing the patients to remain ambulant and that headache and dizziness were significantly less frequent than in a comparable study in which we had used metrizamide. After undergoing myelography with iopamidol by either direct puncture (n = 120) or lumbar puncture and run up of the contrast medium (n = 232), the patients were randomly allocated into one of two groups, one group being confined to bed for 24h and the other allowed to be fully ambulant. Questionnaires recording the occurrence and severity of side effects were completed at specific intervals after the myelogram. Adverse reactions experienced were significantly fewer than in our previous direct puncture study using metrizamide. Neither in the direct puncture nor in the run up group were side effects adversely affected by allowing the patients to remain ambulant after the examination. There is, therefore, no necessity to confine patients to bed following cervical myelography. After cervical myelography by direct puncture at C 1/2 level, 120 patients were randomly allocated to one of two groups, in one the patients were allowed to be fully ambulant and in the other the regimen was bed rest for 24 h. Questionnaires recording the frequency and severity of side effects were completed at intervals after the examination. Headache, nausea and vomiting were common; fits and mental changes occurred also but were uncommon. The incidence and severity of these side effects did not differ significantly between the two groups.
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.