Choi Jeong Sil, Chang Sun Ju
Associate Professor, College of Nursing, Gachon University, Incheon, South Korea.
Assistant Professor, College of Nursing, Seoul National University, Seoul, South Korea.
Worldviews Evid Based Nurs. 2018 Feb;15(1):45-53. doi: 10.1111/wvn.12236. Epub 2017 Jul 29.
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.
尽管建议在脊髓麻醉后卧床休息以预防硬膜穿刺后头痛的发生，但目前的文献表明，卧床休息并不能很好地预防头痛，反而会增加诸如背痛等其他并发症的风险。然而，关于硬膜穿刺后适当的卧床休息时间的信息却很少。
本研究的目的是比较脊髓麻醉后不同卧床休息时间的硬膜穿刺后头痛和背痛的发生率。
本研究是一项实用、平行组、双盲和随机对照试验（试验注册号KCT0001797）。2013年12月至2014年6月，共有119例接受脊髓麻醉手术的患者参与了本研究。参与者被随机分为三组：立即活动组（n = 45）、4小时卧床休息组（n = 40）和6小时卧床休息组（n = 34）。分别使用迪特曼量表和视觉模拟量表测量头痛和背痛的严重程度。由一名对分组情况不知情的研究人员在术后连续5天收集数据。
三组之间头痛发生率无显著差异。然而，6小时卧床休息组的背痛发生率更高，且明显比其他组更严重。
脊髓麻醉后卧床休息并不能预防头痛的发生，反而增加了背痛患者的发生率，因此不建议这样做。这些发现为硬膜穿刺后患者建立循证护理实践提供了信息。
