Incidence of Post Dural puncture headache in elective cesarean section patients following spinal anesthesia at Kenyatta National Hospital

Abstract

Title Incidence of PDPH in elective cesarean section patients undergoing spinal anesthesia at KNH. Background Post dural puncture headache (PDPH) is an iatrogenic complication of neuraxial anesthesia and results from the puncture of the dura mater. As female sex and young age are purported risk factors, the complication is common in the obstetrical population, who frequently receives epidural or spinal analgesia and anesthesia during labor and delivery. This study assessed the incidence, onset time and severity of PDPH and other symptoms associated with PDPH, in elective cesarean section patients under going spinal anesthesia at KNH. Methods This was a prospective observational descriptive study. ASA I and ASA II patients scheduled for elective CIS under spinal anesthesia were consecutively recruited into the study provided an informed consent was obtained. The study was carried out at the maternity theatre and maternity wards of KNH. Patients were contacted by telephone, on the 14th day post-operatively after they had been discharged from hospital. One hundred and twelve participants were recruited in the study. The study was conducted for a period of 6 months. Approval to conduct the study was obtained from KNH/UON ethics and research committee. An interviewer administered data sheet was used as the main instrument for data collection. Data analysis was done using Statistical package for social sciences version 15.0 software for windows. Data was analyzed and presented in tables, and pie charts. Results The incidence of PDPH in elective CIS mothers following spinal anesthesia at KNH maternity theatre was 47.5% and the mean age of the mothers was 29.3years. Orientation of the needle bevel perpendicularly to the longitudinal dural fibres was associated with 2.6 times more risk of developing PDPH compared to parallel orientation. This was statistically significant, (p-value 0.013). Onset of headache after dural puncture among the patients who developed PDPHwas 84.5% on the first day, 12.1%, and 1.7% on the second and third days respectively. Headache severity was found to be mild in 29.3%, moderate in 69% and severe in 1.8% of the patients. Out of the 58 mothers who developed PDPH, 12 had other symptoms associated with PDPH: 5 had neck stiffness; 2 had nausea, 2 had vertigo, 1 had blurred vision and 1 had low back pain. One mother had both low back pain and agitation.