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Optimising bed rest period to reduce lumbar punctures after chemotherapy

Randomised controlled trial of bed rest optimisation to reduce obstacles in chemotherapies

Randomised controlled trial of bed rest optimisation to reduce complications in chemotherapies

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The blood vessels that vascularise the central nervous system provide precise and protective properties controlling homeostasis through the physiological blockade termed the ‘blood-brain barrier’. Unfortunately, this protection from pathogens and toxins means that most systemic chemotherapeutic agents cannot pass across either, which is a problem as the central nervous system becomes a sanctuary site for malignant cells in diseases such as acute leukaemia.

The development of lumbar puncture (LP) and intrathecal chemotherapy (ITC) removed this cancerous haematological cell haven and has contributed to the overall effectiveness of treatments and survival outcomes. The procedure is  associated with significant complications, such as post-procedural headache, back pain, nausea and vomiting, bleeding and infection. This multicentre, open-label randomised Chinese study examined the best time for reducing complications.

A total of 390 patients receiving ITC were randomly assigned to one of three groups to undergo bed rest for six, eight, or ten hours after treatment. Of the 390, follow-up was completed by 359 patients aged between 15 and 68. Almost one third of the sample experienced complications. However, the results show that the incidence of complications associated with the six-hour group was significantly higher than the other groups, but the difference was not significant between the eight-hour and ten-hour group.

The eight-hour period of bed rest was tolerated by the patients whereas the ten-hour period less so, suggesting the former is the optimal time. The authors acknowledge the need to study other variables associated with the procedure.

Juan L et al (2018) Investigation of the optimal duration of bed rest in the supine position to reduce complications after lumbar puncture combined with intrathecal chemotherapy: a multicentre prospective randomised controlled trial. Supportive Care in Cancer 26, 9, 2995-3002.

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