Finding Factors Causing Postdural Puncture Headache In Obstetric Patients After Spinal Anaesthesia

Abstract

Objective: Among various recognized factor of spinal headache the single most important causative factor is size of spinal needle. The aim of this study was to determine incidence of spinal headache with 27 GQuincke Babcock spinal needle in Caesarean section patients. Materials and Methods: This observationalcross sectional study was carried out in the Combined Military Hospital Gujranwala and Pakistan Naval Shipping Rahat Hospital Karachi from Jan 2011 to Jan 2013. In 500 Caesarean section (C section) cases preloaded with 1000 ml Ringers Lactate, 27 G QuinckeBabcok spinal needle was used in sitting as well as left lateral position for spinal anaesthesia in all patients using local anaesthesia plain lidocaine 2% 1-2ml.In interspace L 2-3 / L3-4 eitherBupivacaine hydrochloride hyperbaric 0.75 % or 0. 5% was injected. All Caesarean cases were included except contraindicated. Spinal needle Quincke Babcock 27 G alone was used.The results were presented in percentages, mean and standard deviation. Results: A total of 500 patients of c-section were evaluated. Overall incidence of true spinal headache was 2%, failed spinal anaesthesia 4%, spinal needle was changed in 3 %, success rate of 96 % and maternal acceptance 47.4 %. Single pricks were 59.4 % while 2-3 pricks were 40.6 % . Conclusion: Smaller spinal needle has changed the safety profile of spinal anaesthesia in C section cases by very low failure rates and true PDPH a rarity. PDPH will continue as long as dura is punctured but incidence can be decreased by different techniques.