INCIDENCE OF POST DURAL PUNCTURE HEADACHE IN SPINAL ANAESTHESIA FOR CHOLECYSTECTOMY

Abstract

Post dural puncture headache is a significant and well known complication of puncture of the duramater. Historical reference to Post dural puncture headache was recorded by August Bier in 1899. There is a direct correlation between needle size and risk of Post dural puncture headache. This study comprised of 200 ASA grade I and II patients between 15 to 74 years of age of both sexes who underwent elective cholecystectomy. After undergo ing a thorough pre a naesthetic check up each patient received pre - medication one night before surgery and skin sensitivity test was done. Patient was kept nil orally, a baseline pulse rate, blood pressure and oxygen saturation were recorded. Lumbar puncture wa s done in sittin g position at L 2 - L 3 inter vertebral space with Quincke needle (23, 25, 26 G). After assuring a free flow of clear cerebrospinal fluid 4 ml of 0.5 % bupivacaine heavy was injected. After achieving satisfactory block patients were oxygenated by face mask and regular monitoring of pulse rate, blood pressure and oxygen saturation was done and recorded. Statistical analyses was done by applying students ‘t’ test. The mean age of the patient was 41.2 ± 12.2 years and female patients outnumbered their male counter parts (87.5 %). 25G needle was used in maximum number of patients. The incidence of Post dural puncture headache with 23, 25, 26 G was 24.3 %, 9.2 %, 4.1 % respectively. On statistical analysis the Post dural puncture headache was significantly higher with 23G needle as compared to 25 or 26G (p < 0.05). However there is no statistical significance between 25 and 26G needles . The study concluded that the incidence of post dural puncture headache can be reduced to minimum with the use of small sized needles a nd proper technique of spinal anaesthesia by an experienced anaesthesiologist.