The prevention of headache following spinal anaesthesia

Abstract

The efficacy of various methods in preventing headache following spinal anaesthesia was compared in 797 patients. The postspinal headache occurred in 17.8% of the patients in whom the lumbar puncture was done with a 22-gauge needle. The use of a 26-gauge needle reduced the occurrence of the headache to 7.8% (p less than 0.0125) and the administration of 100 mg of indomethacin six hours after the blockade to 10.3% (p less than 0.05) of the patients. The hydration, an infusion of 3000 ml of fluids during the operation day as compared to that of 1500 ml, did not prevent the headache, nor did the recumbency of 24 hours as compared to that of 8-16 hours, nor the prophylactic epidural blood patching. The headache occurred more often in young patients and in patients who had a history of repeating headache or migraine. In the patients with postspinal headache indomethacin relieved pain as effectively as a stronger analgesic-mixture. Other complaints occurring after the blockade were: pain in the lower back in 9.7% and pain in the lower extremities in 7.2% of the patients. The lithotomy position during the blockade predisposed the patients to these complications.