Influence of Season on the Incidence of Postdural Puncture HeadacheA Clinical Audit

Abstract

Introduction: Postdural Puncture Headache (PDPH), even though becoming uncommon, is still one of the distressing postoperative complications after spinal anaesthesia. The reports on the incidence of PDPH are inconsistent, being 2-40% with different sizes of needles. A previous study conducted by us in the winter months in non obstetric cases, found a low incidence of PDPH and authors had suggested that there is a need to examine the association between PDPH and different seasons. Aim: To find out the incidence of PDPH in obstetric population and any finding to differential incidence with different seasons. Materials and Methods: This study was a single centre clinical audit of lower segment caesarean cases under spinal anaesthesia with 25-gauge Quincke needle. The records of summer and winter months were separated as two groups for each year of 2019 and 2020. The cases done in the months of March, April and May formed the summer group, while the October, November and December patients formed the winter group. Results: There was no significant difference between the groups with regard to age (p-value=0.5). The incidence of PDPH was significantly higher in summer months than winter months in two consecutive years (p-value=0.0068). Fourteen out of 390 patients in the summer group and one out of 392 patients of the winter group suffered from PDPH overall. Conclusion: There should be an urgent need to control ambient temperature in patients at risk of PDPH. The optimisation of coincident dehydration is essential.