Bed rest versus early mobilization in preventing post-dural puncture headache in spinal anaesthesia a randomized controlled study

Abstract

Background: Postdural Puncture Headache (PDPH) is a rare occurrence in spinal anaesthesia. Many studies have been done about the possible causes and CSF leakage has been identified as the cause of this headache. Bed rest has been used to control this headache once it occurs but not known whether it could also prevent it. Early mobilization in this study was defined as any posture a patient can resume other than keeping in supine position. . Objectives: To establish whether early mobilization increases chances of developing PDPH in Nsambya hospital. Methodology: This was an open randomized controlled trial. A total of 110 patients were enrolled and randomized in each study arm. Questionnaires were used, and informed consent obtained. Spinal anesthesia was given using a 25 gauge needle. Participants were assessed for PDPH at 6, 12, 24, 48hours and a follow up at one week. Data was analyzed using SPSS study variables were HIV status, BMI, age, gender, number of needle attempts and type of operation Significance level was set at P<0.05). Results: Seventy eight (79.1%) females, the majority of participants were overweight 98(89%). Emergency operations were 62(56.4%) while elective operations (48)43.6%. Laparotomy 14(11.8%), caesarian sections were 72(65.5%), perineum and groin operations were 14(12.7%), trauma and orthopedic were 9(8.2%) and other operations were 2(1.8%). HIV sero positive participants were 15(13.6%) seronegative participants were 93 (84.5%). 12 patients developed PDPH 4(3.6%) from the early mobilization group and 8(7.2%) from the bed rest group though there was no statistical significance P = 0.136 Conclusion: There are no benefits in keeping post spinal patients on bed rest though if PDPH develops lying flat reduces this headache. All those participants who developed the headache were able to improve on paracetamol without other aggressive management like epidural blood patch