Original scientific paper

Incidence and clinical significance of post-dural puncture headache in young orthopaedic patients and parturients

DAGMAR OBERHOFER ; Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb
ALEKSANDRA JOKIĆ ; Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb
JADRANKA SKURIĆ ; Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb
MILKA VUKELIĆ ; Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb, Croatia
IVAN ŠKLEBAR ; Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb, Croatia
DINKO TONKOVIĆ ; Department of Anaesthesiology, Reanimatology and Intensive Care, University Hospital Sveti Duh, Sveti Duh 64, 10000 Zagreb, Croatia

Abstract

Background and Aims: Post-dural puncture headache (PDPH) is a
complication of spinal anaesthesia, influenced mostly by patient’s age, spinal needle size and design and, possibly, female gender. The purpose of this prospective observational study was to compare the frequency and clinical significance of PDPH in two patient groups at high risk for the development of PDPH, namely young parturients and orthopaedic patients, using 26-G and 27-G Quincke needles.

Patients and Methods: The study included 56 parturients undergoing
Caesarean section and 59 orthopaedic patients undergoing arthroscopic knee surgery, who received standard spinal anaesthesia using 26-G or 27-G
Quincke needles. All patients were less than 40 years of age. The patients
were visited on postoperative days 1, 2, and 4 or contacted by telephone and evaluated for the presence, characteristics and severity of headache, backache and other possible complications. Only posture dependent headache was regarded as PDPH with severity graded as mild, moderate and severe. Patient satisfaction was assessed by theirwillingness to have spinal anaesthesia in the future.

Results: Orthopaedic patients were predominantly male (81.4%) and
significantly younger than parturients (27.8±5.5 vs. 33.7±4.7 years,
P<0.0001). Both groups had similar use of 26-G and 27-G needles, one attempt success rate at dural puncture, and high quality of spinal block. The incidence of PDPH in parturients was 14.3% and in orthopaedic patients 13.6%, which was not significantly different. Also, the severity of PDPH was similar, with mild headache in four out of eight PDPH patients in each group. The rate was similar with 26-G and 27-G needles. No patient required an epidural blood patch. Both orthopaedic patients and parturients
expressed high satisfaction rate with spinal anaesthesia (96.6% and 94.6%, respectively).

Conclusion: The rate of PDPH was similar in young orthopaedic patients
and parturients but higher than in the literature. Low rate of severe
headache, no need for epidural blood patch, and high patient satisfaction
with spinal anaesthesia, make 26-G and 27-G Quincke needles an acceptable technique where pencil point needles are not available.

Keywords

Hrčak ID:

105978

URI

https://hrcak.srce.hr/105978

Publication date:

1.6.2013.

Visits: 2.066 *