Posture and fluids for preventing post‐dural puncture headache

摘要: Background Post-dural puncture headache (PDPH) is a common complication of lumbar punctures. Several theories have identified the leakage cerebrospinal fluid (CSF) through hole in dura as cause this side effect. It therefore necessary to take preventive measures avoid complication. Prolonged bed rest has been used treat PDPH once it started, but unknown whether prolonged can also be prevent it. Similarly, value administering fluids additional those normal dietary intake restore loss CSF produced by unknown. This review an update previously published Cochrane Database Systematic Reviews (Issue 7, 2013) on "Posture and for preventing post-dural headache". Objectives To assess combined with different body head positions, well administration supplementary after puncture, onset people undergoing diagnostic or therapeutic purposes. Search methods We searched Central Register Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, trial registries up February 2015. Selection criteria We randomized controlled trials that compared effects versus immediate mobilization, head-down tilt horizontal position, prone supine positions during rest, no/less supplementation, prevention who undergone puncture. Data collection analysis Two authors independently assessed studies eligibility web-based software EROS (Early Review Organizing Software). Two risk bias using criteria outlined Handbook Interventions. We resolved any disagreements consensus. extracted data cases PDPH, severe performed intention-to-treat analyses sensitivity bias. evidence GRADE (Grading Recommendations Assessment, Development Evaluation) created 'Summary findings' table. Main results We included 24 2996 participants updated review. The number each varied from 39 382. Most only two no supplementation. judged overall low unclear. quality was moderate, downgraded because assessment most cases. primary outcome our presence PDPH. There absence benefits associated mobilization incidence (risk ratio (RR) 0.98; 95% confidence interval (CI) 0.68 1.41; = 1568; 9) moderate (RR 1.16; CI 1.02 1.32; 2477; 18). Furthermore, probably increased 1.24; 1.04 1.48; 1519; 12) mobilization. An analysis restricted methodologically rigorous (i.e. allocation method, missing blinding assessment) gave similar results. There supplementation 0.67; 0.26 1.73; 100; 1) 1; 0.59 1.69; 1), 0.94; 0.66 1.34; 200; 2). did not expect other adverse events them review. Authors' conclusions Since previous version review, we found one new study inclusion, conclusion remains unchanged. considered outcomes moderate. As had shortcomings aspects related randomization assessment, evidence. In general, there suggesting routine dural beneficial onset. role