脊髓麻醉後臥床能否預防脊髓麻醉後頭痛

臨床上，有些醫師會建議患者在接受脊髓麻醉後需臥床以防止頭痛發生，但臥床常導致患者不適感，甚至有些患者會發生下肢靜脈控塞。這篇是研究接受脊髓麻醉後臥床不動是否能預防頭痛發生？硬脊膜穿刺後頭痛為脊髓麻醉後最常見的合併症，其主要原因為腦脊液從硬脊膜流出，導致腦脊液容量下降，硬腦膜塌陷下來，拉扯而產生頭痛。患者典型症狀為前額都或枕部頭痛，坐起來時頭痛會加劇，但躺下後頭痛情形會改善。治療方面以臥床、補充水份、止痛藥及施行硬脊膜上血塊填補術。從這篇回顧發現，並沒有任何證據顯示，脊髓麻醉後臥床能預防頭痛發生，硬脊膜穿刺後頭痛並不會危及生命。所以，不建議在脊髓麻醉後以臥床來預防頭痛發生，可容許患者在病床上活動身體。

關鍵字

實證醫學；脊髓麻醉；硬脊膜穿刺後頭痛；臥床；活動

並列摘要

In clinical practice, Some doctors advise patients to remain in bed after a spinal anesthesia to prevent spinal headache, but bed rest often induced patients' discomfort or even complications such as venous stasis in people with risk factors. This review assess prolonged bed rest or immobilization can prevent post-dural puncture headache after spinal anesthesia? Postdural (post-lumbar or post-spinal) puncture headache is the most common complication of spinal anesthesia. It is caused by leakage of cerebrospinal fluid from the dural, resulting in a decrease in CSF volume and pressure may cause a downward pull on pain-sensitive structures resulting in a headache. Patients with PDPH characteristically present with frontal or occipital headache that is exacerbated in an upright position and improved in the supine position. In addition to symptomatic treatments such as bed rest, hydration, administration of analgesics and application of an epidural blood patch. This review found that there is no evidence to support bed rest or immobilization for preventing headache following lumbar puncture. Moreover, PDPH is not a life-threatening condition. Therefore, we suggested that bed rest after lumbar puncture (spinal anesthesia) to prevent post-dural puncture headache should not be routinely recommended. Patient should be allowed to move freely in bed.

並列關鍵字

Evidence-Based Medicine ； Spinal anesthesia ； PDPH(post-dural puncture headache) ； Bed rest ； Mobilization

國際替代計量

脊髓麻醉後臥床能否預防脊髓麻醉後頭痛

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