Post-dural Puncture Headache in the Obstetric Patient: Needle Size, Number of Dural Puncture and Timing of Ambulation

Abstract

Objectives: This prospective study compared the incidence of post-dural puncture headache (PDPH) in obstetric patients undergoing spinal anesthesia for caesarean section from April 2012 to April 2013 in one year. We also evaluated the relationship between needle size, number of dural punctures, timing of ambulation and PDPH after cesarean section. Materials and Methods: A total of 319 American Society of Anesthesiologists (ASA) I-II full term pregnant women, scheduled for caesarean section under spinal anesthesia from April 2012 to April 2013 were evaluated. Spinal anesthesia was performed with hyperbaric bupivacaine plus fentanyl 10 µg, from L3-4 intervertebral space. We recorded the number of attempts for spinal anesthesia, and the timing of ambulation. Each patient was monitored every day for 4 days following caesarean section. Frequency and severity of PDPH were recorded. SPSS 16 was used for data analysis. Results: Needles used were 25G Quincke spinal needle in 243 patients (76.2%) and 27G Quincke spinal needle in 76 patients (21.9%). Of 319 patients, there were 315 (95.6 %) in the late ambulation group and 14 (4.4%) in the 6 hour bed rest group. In this study only one patient had the classic symptoms of PDPH, whose spinal block were performed with 25G Quincke spinal needle by residents with more than 2 attempts of lumbar puncture (LP). Severe PDPH was not observed in 27G Quincke group. Conclusion: Although our study was performed in a teaching hospital with more residents of anesthesia attempting the procedure, the incidence of PDPH was lower in this study as compared to other studies. This study also concluded that needle size and early ambulation may have some effect on the incidence and characteristics of PDPH.

Comparison of post-dural puncture headache- incidence and severity in obstetric patients after spinal anesthesia for caesarean section with 25G and 27G quincke needle

“…20 Present findings are in congruence with that of Rasooli S et al whose observations again linked the occurrence of PDPH with multiple attempts at subarachnoid block.…”

Magnitude of post dural puncture headache and associated factors in obstetric mothers undergone spinal anesthesia for caesarean section

“…In our study, 85/391 obstetric mothers (21.7%) develop PDPH. This finding is relatively higher as compared to studies conducted by Abdullayev et al, 17 Rasooli et al, 18 and Shaikh JM et al, 19 which report the prevalence of PDPH as 9%, 1.9%, and 4.8% respectively. We concluded that, the higher prevalence of PDPH in our study is contributed by wide spread utilization of large bore and quincke type spinal needle (18G, 20G & 23G) as compared to the previous studies which used fine quincke type as well as a traumatic needle spinal needle.…”

“…However, some other studies 17,26,27 failed to demonstrate a statistically significant deference in the incidence of PDPH between 26-G cutting spinal needle and 26-G a traumatic spinal needle, 25-G Quincke spinal needle and 27-G Quincke spinal needle, and 25-G quincke needle versus 27-G quincke needle versus 27-G whitacre needle, respectively. From these findings, we recognize that, the needle design become more determinant for the development of PDPH than gauges of the spinal needle as the gauges of the spinal needle become smaller (≤ 25 G) In addition, our study also found a statistically significant relation between the numbers of spinal attempt and PDPH.…”

The interrelation between body mass index and post-dural puncture headache in parturient women

“…[ 16 ] The PDPH incidence reported by Rasooli et al [ 17 ] who used a 27G Quincke needle, was high compared with other studies. [ 16 17 18 ] We used a 27G Quincke spinal needle and found a PDPH incidence of 8.2% in parturient women. One of the reasons for the different incidences found in parturient women may be the SA technique; inserting the needle parallel to the dura fibers is proposed to reduce PDPH incidence.…”