Effect of 24-Hour Bed Rest versus Early Ambulation on Headache after Spinal Anesthesia: Systematic Review and Meta-analysis

Objectives: We performed a systematic review of the evidence for the effectiveness of bed rest after dural puncture to update current evidence on the topic. Design: The design was a systematic review and meta-analysis. Data Sources: We searched 10 electronic databases in English (Medline, CINAHL, EMBASE, and the Cochrane Controlled Trial Register) and Korean (KISS, KMBASE, NDSL, and RISS) using the terms “post–dural puncture headache,” “spinal anesthesia,” “epidural anesthesia,” and “bed rest” to identify reports discussing the effectiveness of bed rest in preventing post–dural puncture headache (PDPH) after spinal anesthesia from 1980 to 2014. Review/Analysis Methods: Original studies such as randomized and nonrandomized controlled trials, where participants were allocated to an intervention or control group, were included. A total of eight studies that met the inclusion criteria were independently reviewed and encoded by two review authors. To ensure the quality of the eight studies, levels of risk of bias were assessed by two different researchers. The main outcome was the prevalence of PDPH. Results: The included studies indicated that PDPH prevalence did not differ between the group assigned to 24 hours of bed rest and the group assigned to early ambulation. In subgroup analysis, the effect size of clinical factors (severity of headache, day of onset, and needle gauge) and the study characteristics (language and sample size) did not differ between groups. Conclusion: This meta-analysis of studies suggested that long-term bed rest after spinal anesthesia may not be effective in preventing PDPH.