Chien-Jou Tsou
E-Da Hospital, Taiwan
Title: Effect of early ambulation after spinal anesthesia on post-procedural complications
Biography
Biography: Chien-Jou Tsou
Abstract
Background
Postdural puncture headache (PDPH) is a relatively uncommon but important anesthesia-related complication due to leakage of cerebrospinal fluid after spinal anesthesia. The overall reported incidence of PDPH varies from 0.1 to 36%. Although it usually resolves spontaneously after bed resting, PDPH might result in prolonged hospital stay secondary to intractable headache or requires additional intervention such as autologous blood patch. Bed rest for up to 8 hours after spinal anesthesia is a common clinical practice in Taiwan to prevent the development of PDPH. However, the efficacy of complete bed rest in the prevention of PDPH after lumbar puncture is not substantial. Indeed, some clinical observational studies indicate that incidence of PDPH is increased in patients compliant with complete bed resting. Furthermore, prolonged bed lying position may result in low back muscle strain and aggravate lumbosacral radiculopathy. In order to affirm the effects of complete bed resting after lumbar puncture, we changed the institutional policy of postoperative care for patients receiving spinal anesthesia in our hospital, and recorded the incidence of the complications before and after abandonment of routine postprocedural bed resting.
Methods
All patients received spinal anesthesia in the E-Da Hospital, Taiwan from April 2018 to May 2018 were included in this analysis. Our previous standard postoperative care policy for bed resting after spinal anesthesia was constraint the patient in the bed without head or body elevation for 8 hours after lumbar puncture (bed resting group). This care policy was abrogated on xx April 2018 and patients were allowed to move freely on the bed or early ambulate under assistance in the ward after spinal anesthesia (early ambulation group). During the study period, patients were visited at the ward within 24 after operation, and the potential postprocedural complications were recorded. Data were analyzed with Chi-square or two sample t-test, as appropriate.
Results
A total of 140 patients were included in this analysis, but two patients were excluded due to unsuccessful visiting after operation. There were 69 patients in the bed resting group and 69 patients in the early ambulation group. The clinical characteristics, including patient geographical variables, types of operation and operation time, were not different between the two groups. PDPH was reported in 4 cases with an overall incidence of 2.89%, but no patients required additional invasive intervention. The incidence of PDPH was no statistically significant difference between the two groups (4.3% vs 1.4%, bed resting vs early ambulation; P=0.310). More patients in the bed resting group complained of low back pain (10.1% vs 5.8%, bed resting vs early ambulation; P=0.35), and the pain scale of low back pain was significantly higher in patients constrained in the bed (visual analogue scale (VAS) 4.2±1.7 vs 3.0±0.9, bed resting vs early ambulation; P< 0.05). In addition, the overall satisfaction of anesthesia was significantly higher in the ambulation group.
Conclusion
Compared with early ambulation, our study clearly shows that complete bed resting has no effect on prevention of the development of PDPH after spinal anesthesia. In fact, prolonged bed resting is associated with higher incidence and increased pain intensity of low back strain. Patients with early ambulation are also more contented with the anesthesia service. Although freely movable after spinal anesthesia improves the comfort recovery of the patients, we underscore that early ambulation might increase the risk of falls due to residual motor blockade in the lower extremities. Therefore, the practice of early ambulation after spinal anesthesia should be exercised under more careful surveillance in the ward.