Postdural puncture headache: a cross-sectional study of incidence and severity in a new obstetric anaesthesia unit

Abstract

Postdural puncture headache remains a major complication of subarachnoid anaesthesia that bothers the anaesthetist and the young mother. Identification of factors that may affect PDPH after caesarean section under subarachnoid anaesthesia could be critical to policy formulation in an emerging obstetric anaesthesia unit. All patients who had caesarean section under subarachnoid anaesthesia were evaluated in a cross-sectional manner. Only patients in whom 25G Quincke needles were employed for lumbar puncture were recruited for analysis. Patients who met criteria for postdural puncture headache were interviewed on postoperative day 3. The PDPH was further characterized to establish the time of onset, location of headache, limitation of activity of daily living, and methods of management. A total of 119 patients had lumbar puncture for spinal anaesthesia. Spinal anaesthesia was successful in 112 patients, inadequate in 6 patients and failed in one. Twenty-seven patients (22.7%) developed PDPH. There was no difference in the demographic features in the patients who developed PDPH and those without headache. Clinical variables like site and number of attempts at dural puncture (p = 0.82. Chi-square test), traumatic attempts. parasthesia and volume of bupivacaine were not found to be determinants of PDPH. Successful dural puncture was achieved on first attempt in 42.0% (n = 47) of the patients. The PDPH was mainly occipital for most of the women, starting on postoperative day 2 and relieved with liberal fluids and paracetamol. Maternal experience of their caesarean section with spinal anaesthesia was satisfactory in 77.8% (n = 21) of patients and 63% (n = 17) would recommend the technique to other women.