Abstract
Background: Post dural puncture headache (PDPH) has been a problem for patients after dural puncture. It is one of the most frequently occurring complications following spinal anesthesia (SA). It is believed to originate from persistent leakage of cerebrospinal fluid (CSF) through the punctured Dura, greater than the CSF production after lumbar puncture. Although the problem has been widely reported, its magnitude and associated factors has never been studied in our country. Thus, the aim of this study is to assess the magnitude of post dural puncture headache (PDPH) and associated factors after spinal anesthesia among patients in university of Gondar referral and teaching hospital. Methods: An institution based cross sectional study was conducted from February 25-April 10, 2013 in University of Gondar teaching and referral hospital, Gondar, Ethiopia. A total of 116 patients aged 17-74 years were included in the study. Data was collected by interviewing patients using structured and pre-tested questionnaire and reviewing chart. Both bivariable and multivariable logistic regressions were used to determine the association between post dural puncture headache and independent variables. Results: Out of 116 patients who have undergone spinal anesthesia 45 (38.8%) patients developed post dural puncture headache. Sex [AOR=0.2; 95% CI: 0.058, 0.67], repeated attempts [AOR=0.22; 95% CI: 0.09, 0.54], and needle sizes [AOR=5.3; 95% CI: 1.66, 16.93] were found to be significantly associated with Post Dural puncture headache. Conclusion: Prevalence of post dural puncture headache was found to be high among patients in the University of Gondar teaching and referral hospital after spinal anesthesia (SA). The hospital management and the anesthetists of University of Gondar teaching and referal hospital should minimize the incidence of post dural puncture headache by avoiding use of big needles and repeated attempt especially on female patients.
Highlights
Since August Bier reported the first case in 1898, post-dural puncture headache (PDPH) has been a problem for patients following dural puncture
There were 5 cases (4.3%) of failed block that were converted to general anesthesia (GA) and two of these patients have developed Post Dural Puncture Headache (PDPH) (Table 2)
Even though this study indicated very important results, using small sample size, not including very important variables like level of the anesthetist performing the spinal anesthesia (SA), the effect of needle tip on the prevalence of PDPH, and direction of the needle bevel during insertion and only following patients for three days since some patients may develop PDPH till the 7th day after Dural puncture are some of the limitations of the study
Summary
Since August Bier reported the first case in 1898, post-dural puncture headache (PDPH) has been a problem for patients following dural puncture. Even though the IHS reported this, recent studies indicated the latency period to be within 3 days [4,5,6,8,9,10,11,12], and another study conducted in 2012 to evaluate the validity of the diagnostic criteria for Post-Dural puncture headache showed that some patients can suffer from PDPH in the absence of the associated symptoms [4]. Post dural puncture headache (PDPH) has been a problem for patients after dural puncture It is one of the most frequently occurring complications following spinal anesthesia (SA). The aim of this study is to assess the magnitude of post dural puncture headache (PDPH) and associated factors after spinal anesthesia among patients in university of Gondar referral and teaching hospital
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