Girma T, Mergia G, Tadesse M, Assen S. Incidence and associated factors of post dural puncture headache in cesarean section done under spinal anesthesia 2021 institutional based prospective single-armed cohort study.
Ann Med Surg (Lond) 2022;
78:103729. [PMID:
35600186 PMCID:
PMC9121279 DOI:
10.1016/j.amsu.2022.103729]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 12/05/2022] Open
Abstract
Background
Spinal anesthesia is the most commonly used anesthesia technique for Cesarean delivery with 80%–95% prevalence. The most common complication of SA is post-dural puncture Headache which is associated with dural puncture & Cerebrospinal fluid leak. This study aimed to assess the incidence and associated factors of post-dural puncture headache.
Methods
single-armed cohort study design was employed on 412 women from May 2021 to January 2022. Study subjects were selected using systematic random sampling. Descriptive statistics for each variable, binary logistic regression, and multiple logistic regression analysis with 95% CI was carried out.
Results
The overall incidence of post-dural puncture headache in this study was 25.7%. 43.9% of Post dural headache was detected in the 1st 24 h followed by 48 h. Of those who develop Post-dural headaches, 54.1% of them had mild pain, 17.3% of them was moderate pain and 28.6% of them suffered severe pain. The multivariable analysis indicated that BMI>30 kg/m2 [AOR 2.85 95% CI: 1.91–4.25], number of attempts (>3), (AOR = 1.5, 95% CI: 1.19–1.91), and cephalic needle direction (AOR = 5.79 95% CI: 2.27–12.22), were factors associated with increased post-dural puncture headache. While large gauge needle size (AOR = 0.28 95% CI: 0.19–0.42), and greater than 3 years of experience of anesthetist (AOR = 0.44, 95% CI: 0.31–0.62) were associated with decreased incidence of post-dural puncture headache.
Conclusion
The incidence of post-dural puncture headache was higher in BMI>30 kg/m2, greater than 3-time attempts during spinal anesthesia, using low gauge spinal needles, less than 3 years of experience as anesthetist and cephalic needle direction.
Incidence of post-dural puncture headache was 25.7% of this 43.9% of PDPH happen in the first 24 h.
54.1% of mothers who develop PDPH had mild pain while 17.3% and 28.6% of them suffered moderate and severe pain respectively.
Large size spinal needle, greater than 3 attempts, cephalic needle direction, BMI >30 kg/m2, and experience of anesthetist less than 3 years' were factors associated with increased incidence of PDPH.
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