INCIDENCE OF POST-DURAL PUNCTURE HEADACHE IN INDIAN POPULATION: A NEED FOR A RELOOK

摘要

Objective: Subarachnoid blockade or spinal anesthesia has been the standard anesthetic technique for many years for surgery below umbilicus in a fit patient. Post-dural puncture headache (PDPH) has been the cause of worry in such patients which may be sometimes debilitating and may prolong discharge times. As the current research points to 20% incidence of PDPH with the use of 23 gauge needles, we aimed to find out the actual incidence of PDPH in patients undergoing infraumbilical surgeries in our population. We also analyzed the severity of such a headache and the need of any other extra intervention. Methods: A total of 126 consecutive non-pregnant patients posted for infraumbilical surgeries in the winter months were administered spinal anesthesia with 0.5% hyperbaric bupivacaine with 23 gauge quincke needle. The intra-operative management was according to the routine protocol. In the post-operative period in 12, 24 and 48-hr, incidence of a headache with (PDPH) and without postural variation was noted. Any other event was also noted. Results: The mean and standard deviation of age in years was 35.15±12.35. The incidence of PDPH was 9.5%: (n=12) the other type of non-postural, vague headache formed 8.7%. Even among the 12, 7 patients reported headache spontaneously while the other 5 reported only on questioning. All patients were comfortable by 72 hrs except one who had mild pain until 6 day. All patients except one were discharged according the other necessities and not postponed due to headache. th Conclusion: The incidence of PDPH is around 9.5% and none was severe. The patients should be questioned on the incidence of PDPH rather than waiting for spontaneous reporting. Seasonal variations in the incidence need to be explored. There is no need to struggle with smaller gauge needles in cases with technical difficulty in administering spinal anesthesia.