Contenuto dell'articolo principale

Abstract

Scopo: Individuare come il tempo di allettamento e la postura assunta dal paziente dopo rachicentesi possono condizionare l'insorgenza di complicanze e quali interventi infermieristici mettere in atto per attenuarle.

Metodo: è stata condotta una revisione rapida della letteratura consultando le seguenti banche dati: Pubmed, CINAHL e Cochrane Central Register of Controlled Trials, nell'intervallo di tempo compreso tra il 2001 e il 2015

Risultati: su un totale di 407 studi, 5 sono stati individuati come pertinenti al quesito di ricerca, di questi 4 confrontano i diversi periodi di allettamento e 1 la posizione. Cefalea, nausea, vomito e altri sintomi non sembrano diminuire con allettamenti prolungati anche di 24 ore. Mancano evidenze sull'efficacia della mobilizzazione precoce, cosí¬ come sugli effetti di diverse posture assunte dopo la procedura per ridurre l'incidenza delle complicanze. Unico dato statisticamente significativo la differenza di genere nell'insorgenza di cefalea: le donne sembrano essere più a rischio. Gli studi selezionati hanno dimostrato una qualití  metodologica medio-bassa e una elevata eterogeneití , sia nei sistemi di rilevazione adottati per misurare i sintomi, sia nelle caratteristiche e dimensioni delle popolazioni indagate.

Conclusioni: i dati al momento disponibili non permettono di individuare interventi assistenziali relativi ai tempi di allettamento efficaci e basati su solide prove di efficacia per prevenire le complicanze post rachicentesi. Si ritiene pertanto necessario condurre ulteriori studi sperimentali e osservazionali, con elevato rigore metodologico al fine di massimizzare l'efficacia dell'assistenza infermieristica.

Parole chiave: puntura lombare, allettamento, mobilizzazione precoce, posizione, effetti indesiderati, complicanze. 


How the bed rest period and the posture assumed by the patient post lumbar puncture caninfluence the onset of complications:a rapid evidence assessment

Aim: To identify how the bed rest period and the posture assumed by the patient after lumbar puncture can influence the onset of complications, and which nursing interventions to adopt in order to reduce the complications.

Method: A rapid assessment review was performed and the electronic databases PubMed, CINAHL, and the Cochrane Central Register of Controlled Trials were searched between 2001 and 2015.

Results: Initially, 407 studies were retrieved, and 5 of these publications were considered to be eligible for the purpose of the study,4 comparing different periods of bed rest and 1 comparing patients position. Headache, nausea, vomiting and other symptoms, do not seem to reduce with a 24 hours longer bed rest. There is a lack of evidence on the effectiveness of early mobilization, as well as on the effects of different postures after the procedure performed to reduce the incidence of complications. Only a statistically significant gender difference in the onset of the headache was found: women seem to be more at risk. The selected studies showed a medium-low methodological quality and a high heterogeneity in the systems used to measure the symptoms, in the features and dimensions of the investigated populations.

Conclusions: Currently available data do not permit to identify care interventions related to effective bed rest period based on scientific evidences in order to prevent post rachicentesis complications. It is therefore considered necessary to conduct further experimental and observational studies, with a high methodological rigor in order to maximize the effectiveness of nursing care. Keywords: post dural puncture, bed rest, early mobilization, patient position, adverse effects, complication.

Dettagli dell'articolo

Come citare
Zaina, M., Bressan, V., & Caporale, L. (2018). Come il tempo di allettamento e la postura assunta dal paziente dopo rachicentesi possono condizionare l’insorgenza di complicanze: un’analisi delle evidenze. PROFESSIONI INFERMIERISTICHE, 70(4). Recuperato da https://www.profinf.net/pro3/index.php/IN/article/view/449

Riferimenti

  • Afshinmajd, S., Davati, A., Ahmadvand, A., Modara, F., Moghaddmnia, M, & Jaberian, M. (2014). Evaluation of the effects of resting in appearance of post lumbar puncture headache. Acta Medica Iranica, 52(1), 43-45.
  • Arevalo-Rodriguez, I., Ciapponi, A., Munoz, L., Roqué i Figuls, M., & Bonfill Cosp, X. (2013). Posture and fluids for preventing post-dural puncture headache. Cochrane Database Systematic Review, 7, CD009199. doi: 10.1002/14651858.CD009199.pub2.
  • Bezov, D., Ashina, S., & Lipton, R. (2010). Post-dural puncture headache: Part I, Prevention, Management, and Prognosis. Headache: The Journal of Head and Face Pain, 50, 1144-1152. doi: 10.1111/j.1526-4610.2010.01758.x.
  • Bezov, D., Ashina, S., & Lipton, R. (2010). Post-dural puncture headache: Part II, Prevention, Management, and Prognosis. Headache: The Journal of Head and Face Pain, 50, 1482-1498. doi: 10.1111/j.1526-4610.2010.01758.x.
  • Centre for reviews and Dissemination Systematic Reviews (2008). CRD's Guidance for Undertaking Reviews in Health Care, University of York, York.
  • Cramer, B., Stienstra, R., Dahan, A., Arbous, M., Veering, B., & Kleef, J. (2005). Transient neurological symptoms with subarachnoid lidocaine: Effect of early mobilization. European Journal of Anaesthesiology, 22(1), 35-39.
  • Frank, L. R. (2008). Lumbar puncture and post-dural puncture headaches: implications for the emergency physician. The Journal of Emergency Medicine, 35(2), 149-157.
  • Ghaleb, A., Khorasani, A., & Mangar, D. (2012). Post-dural puncture headache. International Journal of General Medicine, 5, 45-51. doi: 10.2147/ IJGM.S17834.
  • Institute of Medicine (IOM) (2011). Findings What Works in Health Care: Standards for Systematic Reviews. Washington DC: The National Academies Press.
  • Kuczkowski, K. M. (2006). The treatment and prevention of post-dural puncture headache. Acta Anaesthesiologica Belga, 57(1), 55-56.
  • Lavi, R., Rowe, J. M., & Avivi, I. (2010). Lumbar puncture: it is time to change the needle. European Neurology, 64(2), 108-113. doi: 10.1159/000316774.
  • Liberati, A., Altman, D., Tetzlaff, J., Mulrow, C., Gí¸tzsche, P., Ioannidis, J., Clarke, M., devereaux, P.J., Kleijinene, J., & Moher, D. (2009). The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. Plos Med PLoS Medicine, 6(7), e1000100. doi: 10.1371/journal. pmed.1000100.
  • Mansutti, I., Bello, A., Calderini, A.M., & Valentinis, M. (2015) Post-dural puncture headache: risk factors, associated variables and interventions. Assistenza Infermieristica e Ricerca, 34(3), 134-141. doi 10.1702/2038.22140.
  • Martini, F., & Nath, J. (2010). Fondamenti di anatomia e fisiologia (Terza ed.). Napoli: Edises
  • Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Plos Med PLoS Medicine, 6(7), e1000097. doi: 10.1371/ journal.pmed.1000097.
  • Murata, Y., Yamagata, M., Ogata, S., Shimizu, K., Ikeda, Y., Hirayama, J., & Yamada, H. (2003). The influence of early ambulation and other factors on headache after lumbar myelography. The Journal of Bone and Joint Surgery, 85(4), 531-534.
  • Pollock, J. E. (2002). Transient neurologic symptoms: etiology, risk factors, and management. Regional anesthesia and pain medicine, 27(6), 581-586.
  • Richardson, W.S., Wilson, M.C., Nishikawa, J., & Hayward, R.S. (1995). The well-built clinical question: a key to evidence-based decisions. ACP J Club, 123(3), A12-13.
  • Silvanto, M., Tarkkila, P., Mäkelä, M., & Rosenberg, P. (2004). The Influence of Ambulation Time on the Incidence of Transient Neurologic Symptoms After Lidocaine Spinal Anesthesia. Anesthesia & Analgesia, 98(3), 642-646.
  • Tejavanija, S., Sithinamsuwan, P., Sithinamsuwan, N., Nidhinandana, S., & Suwantamee J. (2006). Comparison of prevalence of post-dural puncture headache between six hours –supine recumbence and early ambulation after lumbar puncture in Thai patients: a randomized controlled study. Journal of the Medical Association of Thailand, 89(6), 814-820.
  • Thoennissen, J., Herkner, H., Lang, W., Domanovits, H., Laggner, A. N., & Mí¼llner, M. (2001). Does bed rest after cervical or lumbar puncture prevent headache? A systematic review and meta-analysis. Canadian Medical Association Journal, 165(10), 1311-1316.
  • Turnbull, D. K., & Shepherd, D. B. (2003). Post-dural puncture headache: pathogenesis, prevention and treatment. British Journal of Anaesthesia, 91(5), 718-729. doi:10.1093/bja/aeg231.
  • Van Kooten, F., Oedit, R., Bakker, S. L., & Dippel, D. W. (2008). Epidural blood patch in post dural puncture headache: a randomized, observer-blind, controlled clinical trial. Journal of Neurology, 79(5), 553-558.
  • Woodward, S., & Mestecky A.M. (2011). Neuroscience Nursing: Evidence Based Practice, 1st Edition. Oxford: Wiley-Blackwell.
  • Wu, C.L., Rowlingson, A.J., Cohen, S.R., Michaels, R.K., Courpas, G.E., Joe, E.M., & Liu, S.S. (2006). Gender and post-dural puncture headache. Anesthesiology, 105(3), 613-618.