Finding Factors Causing Postdural Puncture Headache In Obstetric Patients After Spinal Anaesthesia
Keywords:
Spinal anaesthesia, Spinal needle, Caesarean section, Postdural puncture headache (PDPH).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
References
Allman K G, Wilson I H. Caesarean section: spinal. In: Oxford handbook of Anaesthesia 3rd ed. Oxford University Press. 2011. Chapter 32. p758.
Chadwick HS. Obstetric anesthesia closed claim update II-ASA. Newsletter 1999:63:6.
Morgan G E Jr, Mikhail M S, Murray M J. Chapter 43 Obstetric anesthesia. In: Clinical Anesthesiology 4th ed. Lange Medical Books/McGraw -Hill Medical Publishing Division.2006. p 892
RodriquesAM, Roy RM. Post lumbar puncture headache. La Revue du praticien 2007; 57:4: 353-7.
Chohan U, Hamdani G A. Post dural puncture headache. JPMA 2003; 53:8-10
Pal A,Acharya A, Pal N D, Dawn S, Biswas J. Do pencil-point spinal needles decrease the incidence of postdural puncture headache in reality? A comparative study between pencil-point 25G Whitacre and cutting-beveled 25G Quincke spinal needles in 320 obstetric patients. Anaesthesia essays and researches 2011; 5(2): 162-6.
Kang SB, Goodnough DE, Lee YK, Olson RA, Borshof JA, Furiano MM et al. Comparison of 26-G and 27-G needles for spinal anaesthesia for ambulatory surgery patients. Anesthesiology 1992; 76(5):734-8.
Tariq MM, Amjad I, Asghar K. Post spinal headache; comparing needles of 25 and 27 gauges for incidence of post spinal headache. Professional Med J 2007;14(3):441-7.
Shaikh JM, Memon A, Memon MA, Khan M. Post dural puncture headache after spinal anesthesia for Cesarean section: A comparison of 25 g Quincke, 27 g Quincke and 27 g Whitacre spinal needles. J Ayub Med Coll Abbottabad 2008; 20:10-3.
Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Post dural puncture headache: A randomized comparison of five spinal needles in obstetric patients. AnesthAnalg 2000:91:916-20.
Naz F, Khan S, Begum A, Malik M, Zareen A. Complications of spinal anaesthesia in C section. Pjmhsonline.com/complications of spinal anaesthesia.htm
Nicola J C. Effective management of the postdural puncture headache. ATOTW 2010;18 : 181-4
Kashif M, Arshad T, The causes, prevention and management of post spinal backache. An overview. Anesth, Pain and Intensive care. 2013
Rashad S, Abdullah J. Maternal satisfaction after spinal anaesthesia in caesarean deliveries. JCPSP 2009; 19 (2): 77-80
Bano F, Haider S, Aftab S, Sultan ST. Comparison of 25 gauge quincke and whitacre needles for postdural puncture headache in obstetric patients. J Coll Physicians Surg Pak 2004; 14: 647-50.
Angle PJ, Kronberg JE, Thompson DE, Ackerley C, Szalai JP, Duffin et al. Dural tissue trauma and cerebrospinal fluid leak after epidural needle puncture: effect of needle design, angle and bevel orientation. Anesthesiology 2003; 99: 1376-82.
RodriquesAM, Roy PM.Post-lumbar puncture headache. Rev Prat 2007; 57: 353-7.
Lambert DH, Hurley RJ, Hertwig L, Datta S. Role of needle gauge and tip configuration in the production of lumbar puncture headache. Reg Anesth 2003; 22: 66-72.
Behzad S, Asjad S, Ahmad A, Rashid I, Umar Z. Postdural puncture headache. Comparison between lumbar puncture needle no 25 G and 27 G. Profess Med 2011;18 (1):51-56
Chohan U, Hamdani G A. Postdural puncture headache. JPMA 2003; 53:8-12
Morros-Vinoles C, Perez-Cuenca MD, Cedo-Lluis, Colls C, Bueno J, Cedo-Valloba F. Comparison of efficacy and complications of 27 G and 29 G Sprotte needles for subarachnoid anaesthesia.Revista Espanola de anestesiologiaryreanimacion. 2002; 49(2) :448-54.
RodriquesAM, Roy PM. Postdural puncture headache. La Revue du praticien. 2007; 57(4):353-7.
Arendt K, Demaerschalk BM,Wingerchuk, DM, Camann W. Atraumatic lumbar puncture needles: after all these years, we are still missing the point? The neurologist 2009; 15(1): 17-20.
Saenghirumvattana R, Tantivitavatan K, Chumnanyech W, Tangsukkasemsun S, Siritongtaworn P. A comparison study between newly designed pencil-point and cutting needles in spinal anesthesia. Journal of the Medical Association of Thailand 2008; 91(1):156-6.
Steinfeld T, Nimphius W, Wurps M, Eberhart L, Vassiliou T, Kill C et al. Nerve perforation with pencil point or short beveled needles: histological outcome. Actaanaesthesiologica Scandinavica 2010;54(8) :993-9
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