Incidence of post dural puncture headache following Caesarean section under spinal anaesthesia at the Aga Khan University Hospital, Nairobi

Abstract

Background: Post dural puncture headache can be a debilitating complication of subarachnoid anaesthesia for a new mother. Successful management of post dural puncture headache requires adherence to clear policies and protocols with close follow up of patients by an experienced obstetric anaesthetist. Objectives: To examine the cumulative incidence and severity of post dural puncture headache in obstetric patients who consented for spinal anaesthesia for Caesarean section. Design: Prospective cohort study. Subjects: All women who underwent Caesarean sections under spinal anaesthesia and fulfilled the inclusion criteria. Setting: Aga Khan University Hospital, a teaching and referral hospital in Nairobi, Kenya. Results: The overall cumulative incidence of post dural puncture headache was found to be 20.35 % but was significantly higher in patients in whom the quincke type of needle was used than in those whose spinal anaesthetics were administered using the pencil point needle (24.2% and 4.5% respectively: p=0.042). Conclusions: The incidence of post dural puncture headache can be significantly reduced in the obstetric population at the Aga Khan University Hospital if the pencil point spinal needle was to be routinely used. We recommend that the Quincke needles should not be used in the obstetric population at the Aga Khan University Hospital.

Postdural puncture headache

“…Cutting needles (Quincke needles) are associated with a higher incidence of PDPH compared to blunt or pencil-point needles (Sprotte and Whitacre needles). Schmittner et al [31] and Gisore et al [32] confirmed the significantly lower incidence of PDPH with pencil-point needles compared to Quincke cutting needles in similar studies (1.7% vs. 6.6%, P = 0.02 and 4.5% vs. 24.2%, P = 0.042). A modification of the Quincke (Atraucan) needle is also available, with a cutting point and a double bevel to cut a small dural hole and then dilate it.…”

Postdural puncture headache: evidence-based review for primary care

“…17 Schmittner et al and Gisore et al confirmed this same finding in their studies in which the use of the Quincke cutting needle was associated with a higher incidence of PDPH compared with the pencil-point needle (6.6% vs 1.7%; p = 0.02 and 24.2% vs 4.5%; p = 0.042). 18,19 Several studies have affirmed that the bigger the bore size of a spinal needle, the larger the dural tear and the greater the incidence of PDPH. 1,2,5,20 However, Schmittner et al failed to demonstrate a significant difference in the incidence of PDPH between 29 G and 25 G Quincke needles (p = 0.6870), 18 suggesting that at very small bore sizes the needle design may be a more important predictor of PDPH than bore size.…”

Impact of spinal needle type on postdural puncture headache among women undergoing Cesarean section surgery under spinal anesthesia: A meta‐analysis

“…After assessing full texts of 26 studies, we excluded 9 trials for a variety of reasons. Four studies were not RCTs . One study was retrospective .…”

“…Four studies were not RCTs. [30][31][32][33] One study was retrospective. 34 One study was a review article.…”