Effect of position on incidence of post-dural puncture headache in patients undergoing caesarean section: A comparative study

Abstract

Background: Postdural puncture headache (PDPH) is an expected complication after lumbar puncture (LP). Spinal anaesthesia (SA) is given to a patient in lateral decubitus or in the sitting position. Our aim is to compare the incidence of PDPH between sitting and lateral decubitus position among patients scheduled for LSCS. Methods: This is a kind of comparative study done on 200 pregnant women scheduled for elective lower segment caesarean section at our tertiary care centre named NRI Institute of Medical Sciences, Chinakakani Andhra Pradesh, India. Patients were randomized into two groups as per the position used for spinal anaesthesia. Group S(sitting) included 100 patients and group D (lateral decubitus) included 100 patients. Results: There is no significant difference in the mean age, mean BMI and ASA grade of patients in both groups. The incidence of post-dural puncture headache was more common in sitting group patients on a postoperative day 1 compared to lateral decubitus group patients. The intensity of headache was more in sitting group patients from days 1 to 3 postoperatively. There is no significant difference in postoperative nausea and vomiting between two groups. Conclusion: The incidence of post-dural puncture headache is more common among patients in the sitting group compared to patients kept in lateral decubitus position. Also, the intensity of headache is more in the sitting group among pregnant women who were scheduled for elective lower segment caesarean section.

Effect of Patient Position during Spinal Anesthesia on the Incidence of Post-Dural Puncture Headache after Cesarean Section

“…16 But the findings of a study undertaken by Kumar et al highlighted that there was an insignificant difference between both groups regarding incidence of nausea and vomiting. 23 The findings of a study done by Chakraborty et al highlighted that the incidence of hypotension was 22.7 percent in sitting position group while 27.3 percent in lateral position group. 25 Doğukan et al asserted in their study that frequency of nausea & vomiting in sitting position group was 58.5% and 75.5% while in the lateral position group was 76.5% and 90.2%, respectively.…”

“…5 Similarly in another study, mean age of the women in sitting position group was 26.7 + 4.8 years while in lateral position group was 26.4 + 4.8 years. 23 The difference in presentation of age groups can be due to geographical as social and cultural practices of the area associated with marriage and pregnancy.…”

“…22 A recent study performed by Kumar and companions elucidated that the incidence of post-dural puncture headache was found more among patients in sitting position group (12.0%) when compared with patients in lateral position group (1.0%) in 1st postoperative day. 23 A meta-analysis conducted by Zorrilla-vaca and fellows demonstrated that the lateral decubitus position was related to a significant decrease in the PDPH incidence when compared to the sitting position. However, only three out of seven RCTs were included in the meta-analysis that showed an important reduction in the incidence of PDPH with the lateral decubitus position.…”