Incidence and risk factors of postdural puncture headache: prospective cohort study design

Abstract

Background Postdural puncture headache is one of the complications following spinal anesthesia and accidental dural puncture. Several modifiable risk factors contribute to the development of headache after lumbar puncture, which includes needle size, needle design, direction of the bevel, and number of lumbar puncture attempts. This study aimed to assess the incidence and risk of postdural puncture headache. Methods This prospective cohort study design was conducted using a consecutive sampling method. Regular supervision and follow-up were performed. Data were entered into Epi info version 7 software and transported to SPSS version 20 for analysis. The odds ratio and 95% confidence interval were computed. The findings of the study were reported using tables, figures, and narrations. Variables that were found to be candidates (p value < 0.25) on binary logistic regression entered into a multiple logistic regression analysis to identify independent predictors of postdural puncture headache. Results One hundred fifty eligible study participants were included in our study, of which 28.7% had developed postdural puncture headache. This study found that needle size, number of cerebrospinal fluid drops, and multiple attempts were significant independent predictors of postdural puncture headache (p < 0.05). In addition, twenty-five needles were identified as the strongest preoperative independent predictor of postdural puncture headache (AOR = 4.150, CI = 1.433–12.021) Conclusions A recent study revealed that a small spinal needle was much better than a large cutting spinal needle regarding the frequency of postdural puncture headache. In addition, frequent attempts during lumbar puncture and increased cerebrospinal fluid leakage were associated with the events. In view of this, we recommend the use of a small spinal needle to avoid more leakage of cerebrospinal fluid and multiple attempts at spinal anesthesia and lumbar puncture.

Sekar’s DISH10 (Deep Inspiration, Squeeze & Hold for 10 seconds) Maneuver- A Novel, Non-invasive and Cost-effective Treatment for Postdural Puncture Headache – A Comparative Cohort Study

“…Comparing this group with the retrospective cohort (Group 2) evinced reduced time to outcome (treatment duration), making patients ready to discharge. Other fi ndings like the occurrence of PDPH commonly in the younger population (median age in years of Group 1 is 32.5, and Group 2 is 35) and its association with large-bore needles (78% with 25 G Quincke-type and 22% with 27 G Whitacre-type) are consistent with available literature of PDPH [7][8][9][10][11][12][13].…”

Prevalence and associated factors of post dural puncture headache among parturients who underwent cesarean section with spinal anesthesia: A systemic review and meta-analysis, 2021

“…The prevalence of PDPH among the included studies varied from 1.16% [ 19 ] to 48.8 [ 17 ]. Regarding study design, three studies [ 15 , 19 , 20 ] employed a cross-sectional design; four cohort studies [ [16] , [17] , [18] , 27 ] and two RCT studies [ 21 , 22 ]. Furthermore, concerning the study population, 7 studies [ [28] , [29] , [30] , [31] , [32] , [33] ] were conducted only on parturients [ [15] , [16] , [17] , [18] , 20 , 21 , 27 , 34 ] whereas the remaining two were done on all patients from whose we extracted data of cesarean section [ 19 , 22 ] ( Table 1 ).…”

Backstabbed: routine lumbar puncture complicated by retroperitoneal hematoma and hemorrhagic shock

“…Nevertheless, the most common complications from an LP include post-LP headache (10%–40%), back pain (up to 16%), and least commonly, infections and spinal hematoma formation (<0.01%) [1] . Uncommon cases of retroperitoneal abscess formation from dural laceration in patients with meningitis have been reported [ 1 , 2 ]. Although rare, retroperitoneal hemorrhage from arterial injury is a known complication after certain procedures such as percutaneous coronary intervention and nerve blocks [9] , [10] , [11] , [12] however, only a few cases have been reported after an LP [ 5 , 6 ].…”

“…Post-LP headache and local discomfort are common but generally well tolerated complications [1] . Uncommon and more serious complications are infection, spinal hematoma, retroperitoneal abscess formation, intracranial and intraspinal hemorrhage, and brain herniation [2] , [3] , [4] . Although retroperitoneal hemorrhage from a punctured artery is a known complication after percutaneous coronary intervention or spinal anesthesia, the incidence of retroperitoneal hemorrhage after an LP is low with only a few case reports in current literature [ 5 , 6 ].…”