Assessment of risk factors for postdural puncture headache in women undergoing cesarean delivery in Jordan: a retrospective analytical study

Abstract

PurposePostdural puncture headache (PDPH) is one of the most recognized complications after spinal anesthesia in women undergoing cesarean delivery. This study aimed to investigate the incidence of PDPH and its associated risk factors in women undergoing cesarean delivery in Jordan.Patients and methodsThis study included all women who underwent cesarean delivery at King Abdullah University Hospital in Jordan during 2015. Patient characteristics including age, weight, occurrence of PDPH, needle type, repeated puncture attempt, history of spinal anesthesia and PDPH, presence of tension headache, preeclampsia, migraine, sinusitis, and caffeine withdrawal were collated from hospital records. Statistical analyses were performed to assess the association of these characteristics with PDPH.ResultsThe study cohort consisted of 680 women. Among these, only 43 (6.3%) had developed PDPH. The only factors that showed significant association (P<0.01) with PDPH were repeated puncture attempt and presence of tension headache. The repeated puncture attempt increased the risk of PDPH 2.55-fold, while presence of tension headache increased the risk 4.60-fold. Furthermore, the use of the traumatic 27 G Spinostar needle increased the risk of repeated puncture attempt 28.45-fold (P<0.01) compared with the use of the pencil-point 25 G Whitacre needle.ConclusionThe major risk factors associated with the incidence of PDPH in women undergoing cesarean delivery in Jordan are repeated puncture attempt and presence of tension headache. The use of the pencil-point 25 G Whitacre needle is recommended since this was associated with a substantially reduced risk of repeated spinal puncture than the traumatic 27 G Spinostar needle.

Effect of reinsertion of the spinal needle stylet after spinal anaesthesia procedure on post dural puncture headache in women undergoing caesarean delivery

“…[ 17 ] No relationship was found between history of past PDPH and occurrence of PDPH. [ 11 18 ] In our study, past PDPH was not associated with occurrence of PDPH. However, we found that previous spinal anaesthesia or previous CD increased the incidence of PDPH.…”

“…The role of past history of PDPH on occurrence of PDPH is conflicting. [ 11 17 18 19 20 ] An increased incidence of PDPH was reported in patients with a history of PDPH (19%) compared with no such history (6.9%). [ 17 ] No relationship was found between history of past PDPH and occurrence of PDPH.…”

Intracranial Subdural Hematoma after Spinal Anesthesia: Report of Two Cases with different Outcomes

“…4,9 In addition, factors related with the puncture technique (multiple attempts or inadvertent dural puncture during the procedure), with the size of the needle, and with the thickness of the dura seem to change the complication rates in this scenario. 10,11 Finally, the use of anticoagulants in the pre-or postoperative period can lead to higher rates of complications in spinal anesthesia. 7 Often, SDH can present with contralateral paresis and paresthesias, seizures, change of level of consciousness, and severe headache that are not related to orthostatism.…”

Inzidenz, Risikofaktoren und Krankenhausverweildauer des postpunktionellen Kopfschmerzes nach Spinalanästhesie in der Unfallchirurgie und Geburtsmedizin

“…Dies mag daran liegen, dass in beiden Kollektiven die Mehrheit der Punktionen mit einer Nadelgröße kleiner oder gleich 25G durchgeführt wurden. Man kann also konstatieren, dass die Nadelgröße, sofern sie wie in der Literatur empfohlen (25-27G) benutzt wird[7], mittlerweile einen zu vernachlässigenden Risikofaktor darstellt und somit zur Prävention des PKS andere Faktoren in den Vordergrund rücken.Ein gewichtigerer Faktor für das Vorkommen eines PKS könnte die Eigenanamnese der Patienten mit einem häufigen Auftreten von Kopfschmerzen oder Migräne sein[23,24,37,92]. Auch der bereits stattgehabte postspinale Kopfschmerz könnte zu den heute bedeutenderen Risikofaktoren gehören[24,25].…”