Incidence and Prediction of Postdural Puncture Headache A Prospective Study of 1021 Spinal Anesthesias

Abstract

The incidence of postdural puncture headache (PDPH) was investigated prospectively in 873 consecutive patients undergoing a total of 1021 spinal anesthesias, and its association to age, sex, needle size, number of attempted dural punctures, needle bevel direction, duration of postoperative recumbency, and previous PDPH was analyzed. Multivariate analysis showed that age (P less than 0.0001), direction of the bevel of the needle when puncturing the dura mater (P = 0.022), and a history of previous PDPH (P = 0.018) were significant predictors of PDPH. The estimated relation between PDPH, on the one hand, and age and orientation of the bevel, on the other, enables the anesthetist to predict the risk of PDPH and thereby to choose an acceptable age limit for spinal anesthesia.

Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture – a physiological approach

“…Such a communicating vessel mechanism is in line with the fact that post-spinal headache is less frequent in older individuals with their more stiff vessels than in younger individuals (1,(7)(8)(9)(10)14). This mechanism also means a smaller transcapillary filtration rate at a state of disrupted BBB, as also indicated from the skeletal muscle experiments (19), a mechanisms which may contribute to the fact that brain stem compression after LP is less common in adults that in young individuals.…”

“…It is generally believed that post-spinal headache is an effect of sagging of the brain and traction on pain-sensitive structures due to leakage of CSF (1,3,4,(14)(15)(16)(17). Leakage of CSF, which must be relatively slow, however, is not consistent with the fact that post-spinal headache appears momentarily when changing from supine to upright position and disappears immediately after returning back to supine position.…”

A reinserção do estilete não afeta a incidência de cefaleia pós-punção dural (CPPD) após raquianestesia

“…In our study, PDPH was more often observed in patients with one dural puncture and this was statistically signifi cant (p = 0.022). In previous studies, Lybecker could not fi nd a signifi cant interaction between PDPH and number of punctures (p = 0.091) 26 on 1021 patients but Seeberger found that repeated dural punctures signifi cantly increased the incidence of PDPH 4 on 8,034 patients. Our study was not designed for analyzing infrequently occurring predictors of PDPH such as repeated dural puncture.…”

“…This subgroup of patients is older than the others (mean age = 65.6) and we are assuming that this statistically signifi cant data is related to the age of patients in this group 14,26 . In our study, PDPH was more often observed in patients with one dural puncture and this was statistically signifi cant (p = 0.022).…”

Perioperative Management of post dural puncture headache

“…The incidence of headache after lumbar puncture is less if the needle is inserted with the bevel parallel to the dural fibres rather than perpendicular [23]. This separates the fibres rather than cutting them.…”