Assessment of the Prevalence and Associated Risk Factors of Post Dural Puncture Headache (PDPH) after Cesarean Section Delivery under Spinal Anesthesia

Abstract

Background: Post-Dural Puncture Headache (PDPH) is a common problem after a deliberate puncture of the dura-arachnoid for the purposes of diagnosis, therapy, spinal anesthesia, or unintentionally during epidural procedures. It is a clinically main complication which affects the daily life of patients with marked restriction of their physical activities. Spinal anesthesia is the frequent anesthetic procedure for obstetric patients which identified as cause for PDPH. The aim of the study was to assess the prevalence and associated risk factors of PDPH after Cesarean Section (CS) delivery under spinal anesthesia.Method:An institution based cross sectional study design was conducted on all eligible obstetric patients who came for operation under spinal anesthesia from September, 2015 to January,2016. The data collection method was including chart review and patient follow up for three days of post operative period.Results: 107/251 (42.6 %) patients developed PDPH. Among those patiens with PDPH big needle sizes (AOR=8.6; 95% CI: 0.06-0.46) and repeated number of attempts (AOR= 4.54; 95% CI: 0.52 -39.14), were found to be significantly associated with the dependent variable of PDPH on the multi variate logistic regression. Conclusion and recommendation:In this study, we showed the prevalence of PDPH was higher, 107/251 (42.6 %) compared with other literatures. The study also showed that big spinal needles and repeated number of attempts were the independent associated risk factors for PDPH in Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. The higher magnitude of PDPH has to be reduced by avoiding use of big needles, and the repeated dura puncture.

Incidence and Factors Associated with Postspinal Headache in Obstetric Mothers Who Underwent Spinal Anesthesia from a Tertiary Hospital in Western Uganda: A Prospective Cohort Study

“…This study found that women who had 2, 3, and >3 puncture attempts were, respectively, 8, 28, and 20 times more likely to develop PSH as compared to those who had 1 attempt. This is consistent with a study done in Cuba [ 20 ] and the one done by Tarekegn et al [ 4 ] in Ethiopia. The number of puncture attempts is a reflection of the magnitude of damage that is caused, resulting in more sites from which CSF is lost; therefore, fewer attempts result in a lower incidence of PSH.…”

“…The incidence of PSH in this current study is lower than 48.8% obtained in a study done by Nambooze et al [ 5 ] at Mulago National Referral Hospital Uganda, and 42.6% from the study done by Tarekegn et al [ 4 ] at Felege Hiwot Referral Hospital, Bahir Dar. This discrepancy may be attributed to the differences in preoperative hydration, study settings, and the size of the needle used in majority of cases.…”

“…The global incidence ranges between 5–30% [ 3 ], but some countries still report higher incidences. In Ethiopia, one study reported an incidence of 42.6% [ 4 ] whereas in Uganda, an incidence of 48.8% was reported [ 5 ].…”