A Comparison of the Incidence of Post-Dural Puncture Headache and Backache After Spinal Anesthesia: A Pragmatic Randomized Controlled Trial.

Abstract

Although bed rest is recommended after spinal anesthesia to prevent the occurrence of post-dural puncture headache, current literature suggests that periods of bed rest did not prevent headache as well as increase the risk of other complications such as backache. However, information is scarce regarding an appropriate period of bed rest following a dural puncture. The aim of this study was to compare the incidence of post-dural puncture headache and backache after different periods of bed rest following spinal anesthesia. This study was a pragmatic, parallel-group, blinded, and randomized controlled trial (trial registration number KCT0001797). A total of 119 patients who underwent surgery under spinal anesthesia participated in this study from December 2013 to June 2014. The participants were randomly allocated to three groups: the immediate mobilization group (n = 45), 4-hour bed rest group (n = 40), and 6-hour bed rest group (n = 34). The severity of headache and backache was measured using the Dittmann scale and a visual analogue scale, respectively. Data were collected for 5 consecutive days postoperatively by one researcher blind to the group allocation. No significant difference in the incidence of headache among the three groups was detected. However, the incidence of backache in the 6-hour bed rest group was higher and was significantly more severe than the other groups. Bed rest after spinal anesthesia did not prevent the occurrence of headache and increased the incidence of patients experiencing a backache and, therefore, is not recommended. The findings provide information for establishing evidence-based nursing practices for patients after a dural puncture.