Impacto de la ambulación temprana en la reducción de cefalea y dolor lumbar en pacientes sometidos a anestesia espinal: Revisión sistemática y meta-análisis de estudios experimentales

• Olga L Cortés ^[1] ; Maribel Cantor ^[2] ; Luz A Mantilla ^[3] ; Diana M Betancourt ^[4]
  1. [1] Universidad Industrial de Santander

     Universidad Industrial de Santander

     Colombia

     
  2. [2] hospital San Vicente de Arauca
  3. [3] Clínica Carlos Ardila Lulle
  4. [4] Fundación Cardio-Infantil

  Mostrar afiliaciones +
• Localización: Ciencia y enfermería, ISSN-e 0717-9553, Vol. 16, Nº. 3, 2010, págs. 73-83
• Idioma: español
• DOI: 10.4067/S0717-95532010000300009
• Títulos paralelos:
  • Impact of early ambulation on the reduction of headache and back pain after spinal anaesthesia: A systematic review and meta-analysis of experimental studies
• Enlaces
  • Texto completo
• Resumen
  • español

    Objetivo: Determinar el impacto de la ambulación temprana (AT) en la presencia de cefalea y dolor lumbar en pacientes sometidos a procedimientos quirúrgicos bajo anestesia espinal. Material y método: Revisión sistemática y meta-análisis que revisó las bases de datos MEDLINE, CINAhL online, HealthStar, EMBASE, el Cochrane Library Controlled Trials Registry, LILACS y consulta de expertos. Incluyó estudios experimentales aleatorizados en cualquier idioma comparando pacientes sometidos a anestesia subaracnoidea aleatorizados durante su hospitalización a un grupo de ambulación temprana (intervención) o a un grupo control/cuidado estandarizado (reposo cama). La elegibilidad y la calidad de los artículos fue realizada por cuatro revisores de manera independiente. Luego se realizó la extracción de la información. Se calculó riesgo relativo (RR), 95 % de intervalos de confanza usando el modelo de efecto random. Resultados: Respecto de la cefalea y dolor lumbar 24 h posteriores a la anestesia espinal se identificaron seis estudios entre 1988-2008, teniendo en cuenta los criterios de elegibilidad. Se observaron 41 cefaleas (16.9% de 242) y 24 dolor lumbar (21.6% de 111) entre pacientes asignados a una ambulación temprana (DT), comparado con 54 cefaleas (22.3% de 207) y 32 dolor lumbar (27.5% de 116) entre pacientes con anestesia espinal asignados al grupo control (RR=0.67, 95% CI 0.44,1.02; y RR= 0.79, IC 95% 0.46, 1.34 respectivamente). Conclusión: El meta-análisis sugiere que puede existir beneficio hacia una disminución de cefalea y dolor lumbar en pacientes que reciben AT posterior a anestesia espinal.

  • English

    Objective: To determine the impact of early ambulation (EA) versus late ambulation on total headache and back pain after spinal anaesthesia. Design: Systematic review and meta-analysis, used data Sources such as MEDLINE, CINAhL online, HealthStar, EMBASE, the Cochrane Library Controlled Trials Registry, LILACS and experts. Methods: Published randomized controlled trials in all languages comparing spinal anesthesia patients allocated to any in-hospital early ambulation or a control/standard treatment (bed rest). Four reviewers independently assessed study eligibility and quality; and also performed data extraction. We calculated relative risks (RRs) and 95% confdence intervals (CIs) using the random-effects model. Outcomes: cefalea or back pain 24 h post-spinal anaesthesia. Results: Six studies met our eligibility criteria published between 1988-2008. There were 41 cefalea events (16.9% of 242) and 24 back pain events (21.6% of 111) among patients receiving EM, compared with 54 cefalea events ( 22.3% of 207) and 32 back pain events (27.5% of 116) among spinal patients receiving control treatment (for cefalea RR=0.67, 95% CI 0.44,1.02; and for lumbar pain RR= 0.79, IC 95% 0.46, 1.34). Conclusion: Our meta-analysis suggests that there is a possible beneft towards decreased cefalea and back pain with EA after spinal anaesthesia.

• Referencias bibliográficas
  • Rodgers, A,Walter, N,Schung, S,McKee, A,Kehlet, H,Zundert, D. (2000). Reduction of postoperative mortality and morbidity with epidural or...
  • Schneider, M,Ettlin, T,Kaufmann, M,Schumacher, P,Urwyler, A,Hamp, P.K. (1993). Transient neurologic toxicity after hyperbaric subarachnoid...
  • Sudlow, C,Warlow, C. (2008). Posture and fluids for preventing post: dural puncture headache. 2. The Cochrane Library, Copyright. Oxford.
  • Tong, D,Wong, J,Chung, F,Friedlander, M,Bremang, J,Mezei, G. (2003). Prospective study on incidence and functional impact of transient neurologic...
  • Whizar, VM,Martínez, N. (2004). Polémicas en Anestesia Subaracnoidea. Anestesia en México.
  • García, MJ,Meléndez, HJ. (2003). Náusea y dolor en cesárea: Incidencia de náusea y dolor transoperatorio bajo diferentes técnicas de anestesia...
  • Aguilera-Castro, F. (1995). Manejo de la cefalea post: punción accidental de la duramadre. Rev Col Anest. 23. 313-320
  • Cramer, BG,Stienstra, R,Dahan, A,Arbous, MS,Veering, BTh,Van Kleef, JW. (2005). Transcient neurological symptom with subarachnoid lidocaine:...
  • Hampl, KF,Schneider, MC,Ummenhofer, W,Drewe, J. (1995). Transient neurologic symptoms after spinal anesthesia. Anesth Analg. 81. 1148-1153
  • Spelina, KR,Farcs, HR,Gerber, MD. (1984). Nausea and vomiting during spinal anaesthesia. Anaesthesia. 39. 132-137
  • Cajina, RE. (2004). Cefalea post: punción dural en pacientes de cirugía electivas sometidos a bloqueo espinal con agujas número 25 G, 26 G...
  • Jadad, AR,Moore, RA,Carroll, D,Jenkinson, C,Reynolds, DJ,Gavaghan, DJ. (1996). Assessing the quality of reports of randomized clinical trials:...
  • Donner, A,Klar, N. (1996). The statistical analysis of Kappa statistics in multiple Samples. J Clin Epidemiol. 49. 1053-1058
  • Oxman, AD,Cook, DJ,Guyatt, Gh. (1994). Users´guides to the medical literature: VI. how to use an overview. Evidence Based Medicine Working...
  • Oxman, AD,Guyatt, Gh. (1992). A consumer's guide to subgroup analyses. Ann.Intern. Med. 116. 78-84
  • Fleiss, JL. (1975). Measuring agreement between two judges on the presence or absence of a trait. Biometrics. 31. 651-659
  • Le Lorier, J,Gregoire, G,Benhaddad, A,LaPierre, J,Derderian, F. (1997). Discrepancies between meta: analysis and subsequent large randomized,...
  • Der Simonian, R,Laird, N. (1986). Meta: analysis in clinical trials. Cont Clin Trial. 7. 177-188
  • Cook, PT,Davies, MJ,Beavis, RE. (1989). Bed rest and postlumbar puncture headache the effectiveness of 24 hours' recumbency in reducing...
  • Fassoulaki, A,Sarantopoulos, C,Andreopoulou, K. (1991). Early mobilization associated with lower incidence of post spinal headache? A controlled...
  • Lindh, A,Anderson, AS,Westman, L. (2001). Is transient lumbar pain after spinal anaesthesia with lidocaine influenced by early mobilisation?....
  • Silvanto, M,Tarkkila, P,Mäkelä, ML,Rosenberg, Ph. (2004). The influence of ambulation time on the incidence of transient neurologic symptoms...
  • Thornberry, EA,Thomas, TA. (1988). Posture and post: spinal headache a controlled trial in 80 obstetric patients. Br J Anaesth. 60. 195-197
  • Collins, RE,Harding, SA,Morgan, BM. (1999). Effect of maternal ambulation on labour with low: dose combined spinal -epidural analgesia. Anaesthesia....
  • Charles, O,Song, D,Prabhu, A,Chung, F. (2003). Spinal anesthesia: Functional balance is impaired after clinical recovery. Anesthesiology....
  • Golara, M,Plaat, F,Shenan, Ah. (2002). Upright versus recumbent position in the second stage of labour in women with combined spinal: epidural...
  • Watson, MW,Mitra, D,Mclintock, TC,Grant, SA. (2005). Continuous versus single: injection lumbar plexus blocks: Comparison of the effects on...
  • Allen, C,Glasziou, P,Del Mar, C. (1999). Bed rest: a potentially harmful treatment needing more careful evaluation. The Lancet. 354. 1229-1233