DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20170158

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

Sumaya Syed, Nargis Qayoom, Shazia Naaz, Khalida Mushtaq, Aabid Hussain Mir, Akram Hussain Bijli, Zulfiqar Ali

Abstract


Background: The use of neuraxial anesthesia for caesarean section has dramatically increased in last 2 decades because it is easier to perform, safe to the mother and the fetus, and has a high degree of success rate. However, post-dural puncture headache is a well-known complication of spinal anesthesia. It is a common and incapacitating compliation following dura-arachnoid puncture and results in increased morbidity, prolonged hospital stay, increased cost, and patient dissatisfaction.

Methods: It was a double-blinded comparative study conducted on 75 consecutive pregnant patients meeting the inclusion criteria of the study. Patient and anesthesiologist involved in collection of data were blinded to the gauge of the needle used. Standard anesthesia protocol was followed in all the patients and spinal anesthesia performed using 25G Quincke needle in 38 patients and 27G Quincke needle in 37 patients.

Results: we included 75 consecutive patients in the age group 20-35 years in the study. Overall incidence of PDPH was 14.67% (11/75) in present study. 23.68% (9/38) and 5.4% (2/37) patients who received spinal anesthesia with 25G and 27G needles respectively developed PDPH. Difference was statistically insignificant.

Conclusions: The incidence of PDPH was less in patients who underwent caesarean section under spinal anesthesia with 27G needle compared to that of patients in whom block was performed using 25G needles. However, there was no definite advantage of 27G Quincke needle over 25G Quincke needle as far as the incidence of PDPH is concerned.


Keywords


Caesarian section, PDPH, Spinal anaesthesia

Full Text:

PDF

References


Hawkins JL, Gibbs CP, Orleans M, Martin-Salvaj G, Beaty B. Obstetric anesthesia work force survey, 1981 vs 1992. Anesthesiology. 1997;87:135-43.

Andrews WW, Ramin SM, Maberry MC, Shearer V, Black S, Wallace DH. Effect of type of anesthesia on blood loss at elective repeat caesarean section. Am J Perinatol. 1992;9(3):197-200.

Cook TM, Counsell D, Wildsmith JA. Royal College of Anaesthetists Third national audit project. Major complications of central neuraxial block: report on the third national audit project of the Royal College of Anaesthetists. Br. J Anaesth. 2009;102:179-90.

Kuntz KM, Kokmen E, Stevens JC, Miller P, Offord KP, Ho MM. Post lumbar puncture headache: Experience in 501 consecutive procedure. Neurology. 1992;42:1884-7.

Leibold RA, Yealy DM, Coppola M, Cantees KK. Post dural puncture headache: Characteristics, management and prevention. Ann Emerg Med. 1993;22:1863-70.

International classification of headache disorders (1st ed.) International headache society.

Vandam LD, Dripps RD. Long term follow up of the patients who received 10098 spinal anesthetics. JAMA. 1956;161:586-91.

Denny N, Masters R, Pearson D, Read J, Sihota M, Selander D. Postdural pucture headache after continuous spinal anesthesia. Anesth Analg. 1987;66(8):791-4.

Cesur M, Alici HA, Erdem AF, Silbir F, Celik M. Decreased incidence of headache after unintentional dural puncture in patients with caesarean delivery administered with postoperative epidural analgesia. J Anesth. 2009;23(1):31-5.

Carmel A. Assessment: prevention of post lumbar punture headache, special article neurology. 2005,909-11.

Lybecker H, Djernes M, Schmidt JF. Post dural puncture headache: Onset, duration, severity and associated symptoms. An analysis of 75 consecutive patients with PDPH. Acta Anaesth Scand. 1995;39:605-12.

Kuczkowski KM. Post-dural puncture headache in the obstetric patient: an old problem. New solutions. Minerva Anesthesiol. 2004;70:823-30.

Kuczkowski KM. The spinal headache in pregnant women. NJ Obest Gynaecol. 2006;1:4-19.

Tumbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anesth. 2003;91(5):718-29.

Kuzkowski KM. Decreasing the incidence of post-dural puncture headache: an update. Acta Anesthesiol Scand. 2005;49(4):594.

Alam MR, Raheen MR, Iqbal KM, Chowdhury MRA. Headache following spinal anaesthesia: A review on recent update. J Bangladesh coll Physicians Surg. 2011;29:30-42.

Flaatten H, Rodt SA, Vamnes J, Rosland J, Wisborg T, Koller ME. Postdural puncture headache. A comparison between 26 and 29 guage needles in young patients. Anaesthesia. 1989;44:147-9.

Geurts JW, Haanschoten MC, Van Wijk RM, Kraak H, Besse TC. Postdural puncture headache in young patients. A comparative study between the use of 25G and 29G spinal needles. Acta Anesthesiol Scand. 1997;41:779-84.

Shah A, Bhatia PK, Tulsiani KL. Postdural puncture headache in caesarean section: A comparative study using 25G Quincke, 27G Quincke and 27G Whitacre Needles. Indian J Anesth. 2002;46(5):373-77.

Rasooli S, Moslemi F, Baybordi A. Post-dural Puncture Headache in the Obstetric Patient: Needle Size, Number of Dural Puncture and Timing of Ambulation. IJWHR. 2015;3(3):163-7.

Hart JR, Whitacre RJ. Pencil-point needle in prevention of postspinal headache. J Am Med Assoc. 1951;147:657-8.

Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Post-dural puncture headache: A randomized comparison of five spinal needles in obstetric patients. Anesth Analg. 2000;91:916-20.

Shaikh JM, Memon A, Memon MA, Khan M. Post dural puncture headache after spinal anesthesia for Cesarean section: A comparison of 25g Quincke, 27g Quincke and 27g Whitacre spinal needles. J Ayub Med Coll Abbottabad. 2008;20:10-3.