English

Abstract

Post-dural punture headache is known to occur within three days in ninety percent of patients. However early onset is very rare. Hence we report a case of early onset postdural puncture headache with a 26G Quincke's needle occuring within 1 hour of subarachnoid block. CASE REPORT: A 22years old female patient with no history of any medical illness was posted for fissurectomy under subarachnoid block. With the patient in sitting position and under aseptic precautions, a dural puncture was done in L3-L4 interspace with a 26G Quincke's needle with the bevel of the needle parallel to the dural fibres and 1.5ml of 0.5% bupivacaine heavy was given after clear flow of cerebrospinal fluid. Patient was placed in supine position after 15minutes. Level of sensory block was T12. Fissurectomy was performed in lithotomy position and the surgery lasted 20 minutes. Patient's vitals were normal during the intra-operative period. She was hydrated well. Within one hour of spinal anaesthesia, she complained of severe headache. The headache was bilateral frontal and occipital and was aggravated by standing, coughing or straining. It was not associated with photophobia, diplopia, tinnitus, vertigo or nausea and vomiting. Headache was graded 8 on Visual Analogue scale. As she had no past history of migraine or cluster headache, CT Brain was taken which was normal. The diagnosis of post-dural puncture headache was considered as patient had postural headache. Patient was started on supportive treatment with bed rest, paracetamol infusion, adequate hydration with IV fluids and tramadol injection. Symptoms reduced slowly. Supportive treatment was continued for the next three days. Patient was ambulated after three day. Patient had no complain of headache hence further management with epidural blood patch was not considered.