29 Jul, 09 | by John Offen
I have a focussed clinical question! Whilst working on the pain list, I note that patients receiving epidural steroid injections in their spine have to lie down for 20 minutes after their injection. I am told that this is to reduce the chances of them developing a headache following their procedure and that they used to lie down for much longer. I decide to look to see if there is any evidence to back this up. My question is “For patients undergoing lumbar puncture does bed rest result in reduced incidence of headache compared with no bed rest?”. Searching for “lumbar puncture and bed rest and headache” in Evidence Based Nursing (http://ebn.bmj.com/search.dtl), I find an article that seemed to answer the question “McArthur J (2002) Longer bed rest does not prevent more postpuncture headaches than immediate mobilisation or short bed rest. Evidence Based Nursing. 5;87”. I am pleased to find this article because I know that only quality research is summarised in this journal. In addition, the title of the piece answers the question immediately, and the article itself consists of an easily read synopsis of the relevant research (in this case a systematic review of randomised controlled trials) without too much unnecessary detail. The article also includes a commentary which provides a simple explanation of the research and its application to practice. The conclusion appears to be that contrary to the previously perceived wisdom on the subject, there is no evidence to suggest that bed rest after lumbar puncture reduces incidence of headaches. Flushed with success I print both this article and the longer systematic review to which it refers in order to examine them more carefully, and resolve to search for further more recent evidence perhaps in some of the bibliographic databases (for example Medline).