Incidence Of Postdural Puncture Headache Research Articles

The Relationship Between Nutritional Status with Post Dural Puncture Headache Incident in Sectio Caesarea Patients with Spinal Anesthesi

Background: Post dural puncture headache (PDPH) is one of the most common complications of spinal anesthesia caused by leakage of cerebrospinal fluid (CSS) after anesthesia procedures. One of the factors that influence the incidence of PDPH is nutrional status where obese patients tend not to experience PDPH. This is based on an increase intraabdominal pressure in obese patients which can reduce CSF leakage in the epidural space. Purpose: Purpose of this study to determine whether there was a relationship between nutritional status and post dural puncture headache incident in sectio caesarea patients with spinal anesthesia at Aliyah 2 Hospital. Methods: This study used an observational analytic study with a cross sectional approach carried out at Aliyah 2 Hospital. The number of samples in this study was 51 people who were taken using total sampling technique. Data collection was obtained from medical records and filling out observation sheets for post-sectio caesarea patients with spinal anesthesia and then analyzed using the Fisher’s Exact Test. The dependent variable in this study was PDPH and the independent variables was the nutrional status. Result: This study showed that nutritional status (p = 0.007) had a significant relationship with the incidence of PDPH at Aliyah Hospital 2. Conclusion: From this study it could be concluded that the incidence of PDPH after spinal anasthesia is higher in patients with low BMI.

Incidence and associated factors of post dural puncture headache in cesarean section done under spinal anesthesia 2021 institutional based prospective single-armed cohort study

BackgroundSpinal 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. Methodssingle-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. ResultsThe 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. ConclusionThe 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.

Bioimpedance spinal needle provides high success and low complication rate in lumbar punctures of pediatric patients with acute lymphoblastic leukemia

In this prospective single-arm study of 50 pediatric patients with acute lymphoblastic leukemia (ALL), we evaluated the clinical performance of a novel bioimpedance spinal needle system in 152 intrathecal treatment lumbar punctures (LP) of these patients. The system detects in real-time when the needle tip reaches the cerebrospinal fluid (CSF) in the spinal canal. The success was defined as getting a CSF sample and/or administering the intrathecal treatment with one needle insertion. Incidence of traumatic LP (TLP) was defined as ≥ 10 erythrocytes/µL of CSF. Post-procedural complications were monitored with a one-week diary and one-month register follow-up. The success of the first attempt was 79.5%, with the CSF detection sensitivity of 86.1%. The incidence of TLP was 17.3%. A successful first attempt was associated with a significantly lower incidence of TLP (10% vs 40%, p = 0.0015). During the week after the procedure, the incidence of post-dural puncture headache was 6%. During the follow-up, no major complications were observed. In conclusion, the novel bioimpedance spinal needle system achieved a high success rate and low incidence of TLP and other complications in pediatric patients with ALL in a real-world clinical setting, indicating clinical utility for this system in pediatric hemato-oncology.

Assessment of Postdural Puncture Headache in Women Under Elective Cesarean Section: A Randomized Trial Study

Background: Spinal anesthesia is the most common anesthesia technique used for cesarean section. Postdural puncture headache (PDPH) is one of the consequences following spinal anesthesia. Objectives: The primary aim of this study was to compare the incidence of PDPH with 25-gauge Quincke and Whitacre’s spinal needles. Secondary outcomes were mean severity of PDPH, need for analgesic, movement limitation, and associated symptoms and signs followed up for 1 week after surgery. Methods: In this randomized trial study, 130 women were randomly divided into 2 equal groups based on the excel file and random between function. They received spinal anesthesia with either Quincke or Whitacre spinal needles. The incidence of PDPH was followed up 1 week later. Among PDPH women, secondary outcomes and symptoms/signs (such as nausea, vomiting, neck pain, and shoulder pain) were evaluated for 1 week after surgery. Results: All 130 women completed the study. PDPH was observed in 16 women (12.3%), including 6 (9.2%) in the Whitacre group and 10 (15.4%) in the Quincke group, which was not statically significant (P = 0.424). However, secondary outcomes and associated signs and symptoms were more common in the Whitacre group than in the Quincke group, followed up for 1 week in this trial. It can be related to more primary headache history in the Whitacre group than in the Quincke group. Conclusions: Overall, the Whitacre spinal needle is better than Quincke in reducing the incidence of PDPH, but primary headache history in young women causes higher mean severity of PDPH in them. Also, primary headache history causes more associated symptoms and signs in women with PDPH.

Temporal Trends in the Incidence of Postdural Puncture Headache Following Labor Neuraxial Analgesia in the United States, 2006-2015

(Int J Obstet Anesth. 2021;45:90–98) Postdural puncture headache (PDPH) following neuraxial analgesia for labor is associated with several adverse postpartum outcomes including delayed discharge, persistent backache and neurological complications. Thankfully, over the past 2 decades, anesthesia care has improved and anesthesia-related complications have declined. This study examined the temporal trends in the incidence of PDPH following neuraxial analgesia procedures in the United States from 2006 to 2015.

Incidence and Severity of Postdural Puncture Headache following Subarachanoid Block using 25G Quincke and 25G Whitacre Spinal Needles: A Double-blinded, Randomised Control Study

Introduction: Postdural Puncture Headache (PDPH) is the most common complication of dural puncture. Clinical studies have shown that use of small guage needles with pencil point tip is associated with lower incidence and severity of PDPH than with cutting tip needles. Aim: To compare the incidence and severity of PDPH between 25G cutting (Quincke) and 25G non cutting (Whitacre) needles. Materials and Methods: In this randomised controlled study conducted at Jawaharlal Nehru Institute of Medical SciencesImphal, Manipur, India from September 2019 to September 2021. A total of 150 patients of both sexes, age <60 years and American Society of Anaesthesiologists (ASA) grade I and II, undergoing lower abdominal or lower limb surgeries under spinal anaesthesia were enrolled for this study and divided into two groups with 75 patients in each group. Spinal anaesthesia was performed with 25G Quincke needle in one group and 25G Whitacre needle used in other group to compare the incidence and severity of PDPH (severity was determined by limitation of patient activity and treatment required). Results: Overall 14 patients (9.33%) developed PDPH – 2 in the Whitacre spinal needle (2.6%), and 12 in the Quincke spinal needle (16%), with p-value of 0.009. The incidence of failed spinal anaesthesia was significantly higher with Whitacre spinal needle 12 (16%) than with Quincke needle 4 (5.3%), with p-value of 0.03. Incidence of PDPH was more in female patients 12 (14.8%) compared with male patients 2 (2.9%),with p-value of 0.018. Severity of PDPH ranged from mild (n=10) to moderate (n=2) in Quincke needle group, whereas in Whitacre group patients had only mild form of PDPH (n=2). Conclusion: Incidence and severity of PDPH was significantly lower in 25G Whitacre spinal needle than 25G Quincke needle. Failure rate of spinal anaesthesia was more in Whitacre needle than in Quincke needle.

Incidence and Risk Factors of "Postdural Puncture Headache" in Women Undergoing Cesarean Delivery under Spinal Anesthesia with 26G Quincke Spinal Needle, Experience of Medical College in Rural Settings in India 2019: A Prospective Cohort Study Design.

Introduction:Almost every cesarean delivery is done under spinal anesthesia because of ease of doing, rapid onset, avoids maternal and fetal risk of general anesthesia, promotes early recovery. Major complication especially in young women undergoing LSCS under spinal anesthesia is post dural puncture headache (PDPH) which is caused by cerebrospinal fluid leakage. There is wide variation in reported incidence of PDPH (0.3% to 40 %) after spinal anesthesia being affected by various procedure and non procedure related risk factors like age, gender, needle size and type, numbers of spinal attempts and previous history of PDPH.Methods:Prospective cohort study was conducted in 335 patients posted for caesarean section under spinal anesthesia from January 2019 to September 2019 in medical College situated in rural India. Spinal anesthesia was given by 26 G Quincke spinal needle. All patients were evaluated for incidence and severity of PDPH from post operative day 1 to day 5.Result:Incidence of PDPH was 11.4% in this study. Majority of patients (62.5%) were having mild pain. All patients reported PDPH with 72 hours.Conclusion:Body mass index (BMI), h/o PDPH, multiple attempts for successful spinal anesthesia did not have any significant association with PDPH in our study.

Influence of Season on the Incidence of Postdural Puncture HeadacheA Clinical Audit

Introduction: Postdural Puncture Headache (PDPH), even though becoming uncommon, is still one of the distressing postoperative complications after spinal anaesthesia. The reports on the incidence of PDPH are inconsistent, being 2-40% with different sizes of needles. A previous study conducted by us in the winter months in non obstetric cases, found a low incidence of PDPH and authors had suggested that there is a need to examine the association between PDPH and different seasons. Aim: To find out the incidence of PDPH in obstetric population and any finding to differential incidence with different seasons. Materials and Methods: This study was a single centre clinical audit of lower segment caesarean cases under spinal anaesthesia with 25-gauge Quincke needle. The records of summer and winter months were separated as two groups for each year of 2019 and 2020. The cases done in the months of March, April and May formed the summer group, while the October, November and December patients formed the winter group. Results: There was no significant difference between the groups with regard to age (p-value=0.5). The incidence of PDPH was significantly higher in summer months than winter months in two consecutive years (p-value=0.0068). Fourteen out of 390 patients in the summer group and one out of 392 patients of the winter group suffered from PDPH overall. Conclusion: There should be an urgent need to control ambient temperature in patients at risk of PDPH. The optimisation of coincident dehydration is essential.

A Comparison of the Effects of Spinal Anaesthesia between Sitting and Lateral Positions in Patients Undergoing Hysterectomy Surgery

Aim: The main purpose of this present study is to determine the effects of sitting (S) and lateral (L) position during spinal anaesthesia on patient satisfaction, Post dural puncture headache (PDPH), Post-Operative Nausea and Vomiting (PONV).
 Study Design: Prospective comparative study
 Place and Duration of Study: Charusat Healthcare and Research foundation (CHRF), Changa, Gujarat, between September 2021 to November 2021.
 Methodology: A total of 50 female volunteers who were above the age of 18 years, had an American Society of Anaesthesiologist (ASA) status of I & II and those who have undergone hysterectomy surgery are included in this study. The patients were categorized into two groups, group S (n=25) and group L (n=25). Patients were asked about PONV 4 hours after surgery and the possibility of PDPH on post-operative days 1 and 2. The study was analysed by using descriptive statistics, chi-square and Kruskal-Wallis test.
 Results: When comparing the incidence of PDPH on post-operative day 1 and day 2, there is a statistically significant difference between the Sitting (group S) and Lateral decubitus (group L) groups (P-value= 0.14 and.001). On the other hand, there is no statistical significant difference found for PONV when compared between both the groups (P- value= .776).
 Conclusion: Spinal anaesthesia with lateral decubitus position has better outcomes than sitting position for the incidence of Post dural puncture headache. However, there is no difference in both groups for PONV.

Post-dural Puncture Headache in Cesarean Section; Frequency and Risk Factors: A Report From the North of Iran

Background: Spinal Anesthesia (SA) as a safe, reliable, and cost-effective method is widely used for Cesarean Section (CS). However, it is sometimes complicated by Post-Dural Puncture Headache (PDPH). Objectives: We investigated the frequency of PDPH in CS under SA and related risk factors in an academic referral hospital in the north of Iran. Materials & Methods: This descriptive cross-sectional prospective study was conducted at Alzahra hospital as an academic referral center affiliated with the Guilan University of Medical Sciences on 147 eligible cases During from May 2019 to October 2019. Then questionnaires containing questions about patients’ demographic data and some PDPH-related factors were filled out via face-to-face interviews. The collected data were analyzed by SPSS v. 21 using Chi-squared and and Fisher’s exact test. Results: The incidence of PDPH was 6.1%. Early ambulation, the number of attempts, and having a history of headache were significantly associated with a higher incidence of PDPH (P=0.001), while body mass index (P=0.106), age (P=0.093), and residents’ experience (P=0.384) had no significant association. None of our cases experienced a severe or persistent headache. Conclusion: The main predisposing factors for PDPH were found to be the history of HA, early ambulation, and the number of dura punctures. Women at risk for PDPH should be objectively screened before CS under SA.

Influence of demographic profiles and spinal anaesthesia procedures on patients with treated and untreated coffee related to post dural puncture headache pain score

Post Dural Puncture Headache (PDPH) is an iatrogenic complication of spinal anaesthesia (SP) and has devastating consequences. To assess the effect of Coffee on occurrence of PDPH in post-operative patients of Interventional and control groups by comparing the mean PDPH pain scores related to demographic profiles and spinal anaesthesia procedures. An experimental approach in which 60 patients were recruited from the accessible population and was further allocated randomly to Interventional (30) and Control (30) groups. The patients were compared the demographical profiles viz. age, education and marital status and spinal anaesthesia procedures viz. surgery types, needle size and amount of fluid intake related to PDPH pain scores by Numerical Rating Scale after administration of three doses (130mg caffeine in 150ml) of coffee at intervals of 12hrs in Interventional group and only routine care in control group. The main findings in this study were that the incidence of PDPH is lower in Interventional group compared to control group with statistically significant difference (P<0.001) but it is not influenced by demographic profiles as well as SP procedures in Interventional group compared to control group without statistically significant observation after 24 hrs, 48hrs and 72hrs NRS pain score, respectively.The use coffee is an effective, safe, non-invasive treatment for prevention of PDPH.

Rationale of modified paraspinous / paramedian technique for spinal anesthesia in prevention of post dural puncture headache after cesarean section

Background & Objective: The spinal anesthesia in cesarean sections is still marred by post dural puncture headache (PDPH) and low backache. Both complaints sometimes becomes very troublesome for the patient and the anesthesiologists. This study evaluated the incidence of PPDH with modified paraspinous paramedian and median traditional approaches for spinal anesthesia during cesarean sections. Methodology: For this randomized, controlled double-blind study, 60 primigravida parturients undergoing cesarean section under spinal anesthesia were randomized into 2 groups (30 each). Group 1 received spinal anesthesia with the classic median approach and Group 2 received spinal anesthesia with the modified paraspinous paramedian approach. All the patients were followed up to 7 days postoperatively. The incidence of PDPH and low backache was observed in each group. Results: The present study showed a statistically significant lower incidence and lower severity of PDPH in Group 2 in which a modified paraspinous paramedian approach was used, compared to Group 1 (p < .05) in which median classic approach was used. The difference in the incidence of back pain was non-significant. Conclusion: Spinal anesthesia with the modified paraspinous/ paramedian approach for cesarean section is associated with a lower incidence of PDPH when compared to the standard median approach. Key words: Post Dural Puncture Headache; Spinal anesthesia; Median classic approach; Modified paraspinous paramedian approach Citation: Mohamed ZE, Selim MF. Rationale of modified paraspinous / paramedian technique for spinal anesthesia in prevention of post dural puncture headache after cesarean section. Anaesth. pain intensive care 2021;25(4): 487-493. DOI: 10.35975/apic.v25i4.1574 Received: August 19, 2020, Reviewed: December 22, 2020, Accepted: February 18, 2021

A Comparison of Incidence of Post Dural Puncture Headache Using 25G Quincke and 25G Whitacre Needle in Obstetric Patients Undergoing Caesarean Section under Spinal Anesthesia

Introduction: Spinal anesthesia has offered a new armamentarium for the anesthesiologists and has been widely used in the Cesarean section in the field of obstetrics, an alternative to general anesthesia. However, Post Dural Puncture Headache remains an inevitable complication of spinal anesthesia and can be minimized its incidence by reducing the size of the needle and changing the design of the needle tip. The objective of the study was to find the incidence of post-dural puncture headache undergoing subarachnoid block for CS using 25G Quincke and 25G Whitacre needles.&#x0D; Materials and methods: This study was conducted from August 2020 to January 2021 enrolling 72 parturients and were allocated in two groups of 36 each. Group A and B parturients received spinal anesthesia via. 25G Quincke and 25G Whitacre in sitting position respectively. All the patients were evaluated based on incidence, onset, duration, and severity of headache postoperatively for 72 hours after the subarachnoid block.&#x0D; Results: The incidence of post-dural puncture headache in the study was 7.2% in Group A and 3.15% in Group B which was statistically significant (P-value = 0.011), while there were no significant differences between these two groups in the onset, severity, and duration of post-dural puncture headache.&#x0D; Conclusion: Despite no significant differences were found for the onset, severity, and duration of post-dural puncture headache, the use of 25G Whitacre is associated with a reduced incidence of post-dural puncture headache compare to 25G Quincke.

A Randomized Comparative Study on Median and Paramedian Approaches for Subarachnoid Block using Sprotte Needle in the Cesarean Section: Quest for the Best.

Background:Since 1898 when August Bier, introduced spinal analgesia, there is lot of advancement made in the technique. There are various approaches and techniques for subarachnoid block.Aim:The aim of this study is to compare median and paramedian approach for spinal anesthesia for cesarean delivery using Sprotte needle in terms of number of attempts, success rate, adverse effects, and complications.Materials and Methods:One hundred patients were randomly divided into two equal groups and underwent subarachnoid block in median and paramedical block for elective cesarean section.Results:There is no significant difference between the two groups. Mean with standard deviation in the number of attempts for subarachnoid block through media and paramedian approach is 1.18 ± 0.48 and 1.06 ± 0.24, respectively (P = 0.51). The incidence of postdural puncture headache (PDPH) and lower backache was insignificant in both the groups (P = 0.218 and 0.646, respectively).Conclusions:Paramedian approach should not be considered as a reserve technique for spinal anesthesia and can be used as popularly as the median approach.

Post Dural Puncture Headache After Elective Caesarean Section Using 27 G Quincke and Whitacre Spinal Needles: A Comparative Study

INTRODUCTION&#x0D; Post-dural puncture headache (PDPH), a serious complication of spinal anesthesia (SA) may persevere for long time and can be unbearable to the patients. The incidence of PDPH unswervingly relies on the size of the spinal needles used and this gradually decreases with the use of thinner spinal needles.&#x0D; &#x0D; MATERIAL AND METHODS&#x0D; A prospective randomized single blinded study was conducted during the period between 1 to 29 January 2019, at Universal College of Medical Sciences, Nepal. A total of 120 patients (between 20-35 years of age) were divided into two groups: Group I: 60 patients given SA with 27-G Quincke needle and Group II: 60 patients given SA with 27-G Whitacre. Randomization was done by coin tossing method and double-blinded except for the anesthetist performing the spinal block. Patients were interviewed on days 1 to 5 and were questioned with regard to headache based on its severity, location, character, duration, associated symptoms (nausea, vomiting, auditory and ocular symptoms). The severity of the headache was analyzed by Crocker scale.&#x0D; &#x0D; RESULTS&#x0D; The results showed that 33% more headache in group A, but the t-value was 0.727 and p-value was 0.2345 which was statistically insignificant.&#x0D; &#x0D; CONCLUSION&#x0D; Hence, using 27-G Quincke spinal needles does appear to be advantageous to the patients whereas, Whitacre spinal needles are shown to be clearly associated with fewer cases of PDPH.

English

Fine gauze spinal needles are known to decrease the incidence of postdural puncture headache (PDPH) in patients undergoing spinal anaesthesia. We present a rare case of syncopal attack in a patient posted for caesarean section. A patient undergoing elective surgery with inadequate anxiolysis can have a rare chance of a syncopal attack. Hence, high level of suspicion and management of a vasovagal attack is vital. The most common mechanism of syncope is reflex mediated, which can be ‘neurally’ or ‘vasovagally’, and it characteristically develops in the sitting or upright position but may occur in supine position also.1,2 It is characterized by a rapid onset, brief duration, and with a spontaneous recovery. Anxious and apprehensive patients prior to any surgical or anaesthetic procedure can lead to a vasovagal syncope, especially in young females.3 Medline search did not reveal any case report regarding the vasovagal syncope just after spinal needle insertion in young females undergoing spinal anaesthesia. Spinal anaesthesia is the most common anaesthesia performed for lower segment caesarean section (LSCS). A case of syncopal attack with sequence of events, during the insertion of a 25 G Whitacre spinal needle, in a parturient posted for emergency lower segment caesarean section, is discussed here.

P.35 Post-dural puncture headache in a DGH: A decade after MBRRACE-UK

Introduction: The 2009-2012 MBRRACE-UK report identified 2 post dural puncture headache (PDPH) case fatalities that lacked appropriate follow-up. [1] Knight M, Kenyon S, Brocklehurst P, et al. (eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care – Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-12. Oxford National Perinatal Epidemiology Unit. University of Oxford 2014 Google Scholar We audited our PDPH incidence and management, and compared this the standards set by the Obstetric Anaesthetists’ Association (OAA), national data as well as our six previous audits. 2 OAA. Treatment of Obstetric Post Dural Puncture Headache; 2018. https://www.oaa-anaes.ac.uk/assets/_managed/cms/files/Guidelines/New%20PDPH% 20Guidelines.pdf Google Scholar , 3 OAA. Epidural information card; 2016. https://www.labourpains.com/Epidural-Information-Card Google Scholar

The causal-effect of bed rest and post-dural puncture headache in patients receiving diagnostic lumbar puncture: A prospective cohort study.

Post-dural puncture headache (PDPH) is the most common complication of lumbar puncture. Patients who received lumbar puncture were previously suggested to remain in bed for a certain time to prevent PDPH; however, this concept was challenged by recent studies. We aimed to investigate whether ambulation instead of resting supine following lumbar puncture could increase the risk of PDPH. The study used a prospective cohort design, applying convenience sampling among patients who received diagnostic lumbar puncture between January and September 2018 in the neurology ward of a tertiary medical center. The patients who fulfilled the inclusion criteria were informed that the current practice suggests lying supine for 6 to 8 hours after lumbar puncture, but they were allowed to either follow the suggestion or ambulate by their wills. The timing of bed rest was recorded, in addition to other possible risk factors of PDPH. The study endpoint is the presence or absence of PDPH within 48 hours of lumbar puncture. A total of 137 patients who received lumbar puncture were enrolled, including 103 with bed rest following lumbar puncture and 34 without. There was no difference in demographics between the two groups. PDPH was found in 21 patients, with a total follow-up period of 5959 person-hours and an incidence density of 0.35%. There was no significant difference between the incidence of PDPH between the two groups (non-bed rest group 5.9% vs bed rest group 18.4%; p = 0.078), nor was incidence density (non-bed rest group 0.13% vs bed rest group 0.43%, p = 0.113). The results remained the same after adjusting for age. Bed rest following lumbar puncture does not prevent PDPH, and even leads to a marginally increased risk of PDPH. Amendment to the current practice guideline post-lumbar puncture care might be needed to improve patient care.

Comparing the Incidence of Postdural Puncture Headache After Diagnostic Lumbar Puncture due to 22 Gauge Standard Versus 25 Gauge Atraumatic Needle : A Randomized Controlled Trial

Background: There is growing evidence that the incidence of Postdural Puncture Headache (PDPH) after Lumber Puncture (LP) with the smaller, non-cutting needle is less. Nevertheless, larger, cutting needles are still widely used for this procedure in Bangladesh. The aim of this study was to compare the incidence and severity of PDPH between 22 G standard needle and 25 G atraumatic needle for diagnostic LP in patients with neurological symptoms.&#x0D; Methods and materials: This single-blind, randomized, controlled trial was carried out in Department of Neurology, Chittagong Medical College Hospital, during February 2017 to January 2018. One hundred consecutive patients admitted in Neurology ward fulfilled the set inclusion and exclusion criteria were enrolled in the study and randomly divided into two equal groups: Group A (LP was done with 22 G standard needle) and Group B (LP was done with 25 G atraumatic needle). The incidence and severity of PDPH was interviewed on day 5 following LP.&#x0D; Results: Effective sample size was 99 (50 in Group A and 49 in Group B) as one patient was dropped out. Both groups were similar in terms of baseline sociodemographic and clinical characteristics. LP was successful in first attempt in 25 (50%) and 28 (57.8%) patients in Group A and Group B respectively. Incidence of PDPH was significantly higher in Group A than Group B. Severity of PDPH was also significantly higher in Group A than in Group B with regards to presence of moderate degree of PDPH. Analgesics use was significantly less in Group B in comparison to Group A. Absolute adjusted risk of mild to moderate PDPH with 25G atraumatic needles was reduced by 3.74 times (95% CI: 1.22-11.44) compared to 22 G standard needle.&#x0D; Conclusion: 25 G atraumatic needles significantly reduced the incidence and severity of PDPH as compared to 22G standard needle. So, using 25 G atraumatic needle would be beneficial for diagnostic LP procedure.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 67-71

English

BACKGROUND Spinal anaesthesia is the first preference of anaesthesia in obstetric surgery. Post dural puncture headache (PDPH) is more common after C-section in young parturients. In the present world which is developing and fast-paced, brisk recovery along with minimal side effects &amp; importantly early ambulation are now the need of the hour. This headache is more worrying to the mother who is required to tend to the newborn baby. This study compared the incidence of PDPH subsequent to subarachnoid blockade for lower segment Caesarean section (LSCS) 25G Whitacre &amp; 25G Quincke needles. We wanted to compare the incidence of PDPH using 25G Quincke and 25G Whitacre spinal needles in patients undergoing LSCS. METHODS Two hundred (ASA II) American Society of Anaesthesiologists 11 females who were pregnant and in the age group of 20 - 50 years, planned to get sub-arachnoid blockade for C-section, were assigned randomly into two equal groups (N = 100 each). Both groups received spinal anaesthesia with 25-gauge Quincke and 25 gauge Whitacre needle. Postoperatively, incidence, site, onset, severity and duration of headache was studied. RESULTS The incidence of post spinal headache was 6 % in the Quincke group. No patients in Whitacre group had PDPH. The number of lumbar punctures required for successful sub arachnoid block was recorded in both the groups. 92 % patients from group Q and 88 % patients from group W required only one puncture. 8 % patients from group Q and 12 % patients from group W required two punctures. CONCLUSIONS It is prudent to conclude that 25G Whitacre spinal needle is a better alternative to 25G Quincke needle for reducing the incidence of post dural puncture headache in patients undergoing lower segment Caesarean section. KEY WORDS Spinal Anaesthesia, Post Dural Puncture Headache, Caesarean Section