INCIDENCE OF POST-DURAL PUNCTURE HEADACHE IN INDIAN POPULATION: A NEED FOR A RELOOK
Abstract
ABSTRACT
Objective: Subarachnoid blockade or spinal anesthesia has been the standard anesthetic technique for many years for surgery below umbilicus in a
fit patient. Post-dural puncture headache (PDPH) has been the cause of worry in such patients which may be sometimes debilitating and may prolong
discharge times. As the current research points to 20% incidence of PDPH with the use of 23 gauge needles, we aimed to find out the actual incidence
of PDPH in patients undergoing infraumbilical surgeries in our population. We also analyzed the severity of such a headache and the need of any other
extra intervention.
Methods: A total of 126 consecutive non-pregnant patients posted for infraumbilical surgeries in the winter months were administered spinal
anesthesia with 0.5% hyperbaric bupivacaine with 23 gauge quincke needle. The intra-operative management was according to the routine protocol.
In the post-operative period in 12, 24 and 48-hr, incidence of a headache with (PDPH) and without postural variation was noted. Any other event was
also noted.
Results: The mean and standard deviation of age in years was 35.15±12.35. The incidence of PDPH was 9.5%: (n=12) the other type of non-postural,
vague headache formed 8.7%. Even among the 12, 7 patients reported headache spontaneously while the other 5 reported only on questioning.
All patients were comfortable by 72 hrs except one who had mild pain until 6
day. All patients except one were discharged according the other
necessities and not postponed due to headache.
th
Conclusion: The incidence of PDPH is around 9.5% and none was severe. The patients should be questioned on the incidence of PDPH rather than
waiting for spontaneous reporting. Seasonal variations in the incidence need to be explored. There is no need to struggle with smaller gauge needles
in cases with technical difficulty in administering spinal anesthesia.
Keywords: Anesthesia, Spinal, Dural puncture, Headache.
Downloads
References
REFERENCES
Barker P. Headache after dural puncture. Anaesthesia 1989;44(8):696-7.
Ghaleb A, Khorasani A, Mangar D. Post-dural puncture headache. Int J
Gen Med 2012;5:45-51.
Carrie LE. Whitacre and pencil-point spinal needles: some points to
consider. Anaesthesia 1990;45(12):1097-8.
Wulf HF. The centennial of spinal anesthesia. Anesthesiology
;89(2):500-6.
Mehjabeen F, Ghayarool H, Rahida H, Maryam A. Incidence of post-
dural puncture headache in spinal anesthesia for cholecystectomy. J
Pharm Sci Innov 2014;3(2):154-7.
Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis,
Asian J Pharm Clin Res, Vol 9, Issue 2, 2016, 230-232
Parthasarathy and Sivashanmugham
prevention and treatment. Br J Anaesth 2003;91(5):718-29.
Carbajal R, Simon N, Olivier-Martin M. Post-lumbar puncture
headache in children. Treatment with epidural autologous blood (blood
patch). Arch Pediatr 1998;5:149-52.
Norris MC, Leighton BL, DeSimone CA. Needle bevel direction
and headache after inadvertent dural puncture. Anesthesiology
;70(5):729-31.
Reynolds F. Dural puncture and headache. BMJ 1993;306(6882):874-6.
Lybecker H, Møller JT, May O, Nielsen HK. Incidence and prediction
of post-dural puncture headache. A prospective study of 1021 spinal
anesthesias. Anesth Analg 1990;70(4):389-94.
Halker RB, Demaerschalk BM, Wellik KE, Wingerchuk DM, Rubin DI,
Crum BA, et al. Caffeine for the prevention and treatment of post-dural
puncture headache: Debunking the myth. Neurologist 2007;13(5):323-7.
Published
How to Cite
Issue
Section
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.