Bed rest and posture for preventing post-dural puncture headache

NICE Quality and Productivity Case Studies
Queen's University Belfast
Publication date:
09 September 2014


Post-dural puncture headaches are a recognised complication of any procedure where the dura is punctured. The dural puncture may be intentional, with the use of a spinal needle, or unintentional, as a complication of epidural injections or catheterisations. It is thought that cerebrospinal fluid (CSF) leakage through the puncture hole is a key determinant of whether a headache develops, so it was thought that bed rest would reduce fluid leakage by reducing the hydrostatic pressure at the puncture site or fluid supplementation would increase CSF production to compensate for any leak. There are no clear benefits associated with either bed rest or fluid supplementation. It is not current practice for patients to be kept in hospital strictly for bed rest and so this review would not result in the freeing up of beds but there may be cash savings from the reduced use of intravenous fluids.