A STUDY OF POST DURAL PUNCTURE HEADACHE AFTER USING FINE GAUGE SPINAL NEEDLE IN SUBARACHNOID BLOCK

Abstract

J. Leonard Corning1 a neurologist of New York was the rst one to give recorded but accidental spinal anesthesia in 1885 when he pierced the dura while experimenting with cocaine on spinal nerves of a dog. According to International headache society the criteria dened for Post Dural Puncture Headache (PDPH) includes a headache that develops in less than seven days after a spinal puncture, occurs or worsens in less than fteen minutes after assuming upright position and improves in less than thirty minutes after assuming recumbent position with at least one of the following associate (neck stiffness, tinnitus, hypacusia, photophobia and nausea). The headache usually resolves within fourteen days after spinal puncture. In the present study we analyzed the incidence of post spinal headache after using narrow gauge atraumatic needles irrespective of administrator's status. We also analyzed to relate the skill of administration to the incidence of headache. Majority of the patients 1094 (88.58%) included in this study were between the ages of 20 to 60 years, while 63 (5.11%) were below 20 years and 78 (6.31%) were above 60 years of age. Of the 1235 patients included in the study 429(34.74%) patients were male and 806(65.26%) were females. Of the 1235 patients 515 females underwent surgery for obstetric reasons mostly L.S.C.S and rest underwent non obstetric surgeries. Overall PDPH rate observed in 1235 cases was 2.8% i.e. 35 patients had PDPH after using ne gauge spinal needle. Out of these 35 patients who reported having PDPH; in 21 patients (60%) was administered spinal anesthesia using 26G needle and 14 patients were given spinal block with 25G needle. The incidence of PDPH seems higher with 26G needle as most of the patients in our institution receives spinal anesthesia using 26G needle. . Of the 35 cases included reporting having PDPH, trauma occurred in only 6 cases i.e. 17.14% and in rest of the cases LP was atraumatic. 23 out of 35 (65.71%) patients lumbar puncture was done in rst pass in single interspace only, in 5 patients (14.28%) more than one attempt was required but attempts were taken in single interspace with single skin puncture only, in 3 patients (8.57%) more than one attempt accompanied by one skin puncture in one interspace only and lastly in 4 patients (11.42%) multiple attempts in multiple spaces was done. Thus above observations clearly establishes that PDPH occurred more frequently in female in the age group of 20-40 years and majority of them underwent obstetric surgery.