Incidence of Post Dural Puncture Headache (PDPH) Following Subarachnoid Block in Lower Segment Caesarean Section: A Hospital-based Prospective Observational Study
Main Article Content
Keywords
Spinal anaesthesia, Post-Dural Puncture Headache, Caesarean section, Subarachnoid space, Obstetric anaesthesia, Bupivacaine, Lumbar puncture
Abstract
Background: Post-dural puncture headache (PDPH) remains one of the most distressing complications of spinal anaesthesia, particularly relevant in obstetric anaesthesia where subarachnoid block is commonly employed for caesarean sections. This study aimed to determine the incidence of PDPH following subarachnoid block in patients undergoing lower segment caesarean section (LSCS) and identify associated risk factors in a tertiary care hospital in Eastern India.
Methodology: This prospective observational study was conducted over 18 months (January 2019 to June 2020) at Tata Main Hospital, Jamshedpur. A total of 1305 patients undergoing LSCS under subarachnoid block were enrolled. Patient demographics, obstetric history, and anaesthetic technique-related variables—including needle size, number of attempts, and operator experience—were recorded. Patients were followed postoperatively for five days for the onset of headache and assessed clinically for PDPH.
Results: The overall incidence of PDPH was 1.5% (19/1305 patients). Among patients reporting headache, 56% experienced onset within 24-48 hours, with predominantly mild intensity and postural characteristics. The headache duration averaged 27.2±11.6 hours. The number of dural puncture attempts was significantly associated with PDPH occurrence (p=0.030), with incidence rising from 1.2% in a single attempt to 8.3% in ≥2 attempts. No significant associations were found with age, needle gauge, gravida status, operator experience, or bupivacaine dose.
Conclusion: This study demonstrated a low PDPH incidence following spinal anaesthesia for caesarean section. Technical precision in achieving successful first-attempt spinal anaesthesia emerged as the most critical factor in preventing PDPH, emphasizing the importance of operator skill over traditional risk factors.
References
2. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91(5):718-29. doi: 10.1093/bja/aeg231
3. Alatni RI, Alsamani R, Alqefari A. Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review. Cureus. 2024;16(1):e52330. doi: 10.7759/cureus.52330
4. Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth. 2003;50(5):460-9. doi: 10.1007/BF03021057
5. Kwak KH. Postdural puncture headache. Korean J Anesthesiol. 2017;70(2):136-143. doi: 10.4097/kjae.2017.70.2.136
6. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. doi: 10.1177/0333102413485658
7. Lybecker H, Djernes M, Schmidt JF. Postdural puncture headache (PDPH): Onset, duration, severity, and associated symptoms. An analysis of 75 consecutive patients with PDPH. Acta Anaesthesiol Scand 1995;39:605–612. doi: 10.1111/j.1399-6576.1995.tb04135.x
8. Chekol B, Yetneberk T, Teshome D. 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. Ann Med Surg (Lond). 2021;66:102456. doi: 10.1016/j.amsu.2021.102456
9. Ferede YA, Nigatu YA, Agegnehu AF, Mustofa SY. Incidence and associated factors of post dural puncture headache after cesarean section delivery under spinal anesthesia in University of Gondar Comprehensive Specialized Hospital, 2019, cross sectional study. International Journal of Surgery Open. 2021;33:100348. doi: 10.1016/j.ijso.2021.100348
10. Girma T, Mergia G, Tadesse M, Assen S. Incidence and associated factors of post dural puncture headache in cesarean section done under spinal anesthesia 2021 institutional based prospective single-armed cohort study. Ann Med Surg (Lond). 2022;78:103729. doi: 10.1016/j.amsu.2022.103729
11. Al-Hashel J, Rady A, Massoud F, Ismail II. Post-dural puncture headache: a prospective study on incidence, risk factors, and clinical characterization of 285 consecutive procedures. BMC Neurol. 2022;22(1):261. doi: 10.1186/s12883-022-02785-0
12. Weji BG, Obsa MS, Melese KG, Azeze GA. Incidence and risk factors of postdural puncture headache: prospective cohort study design. Perioper Med (Lond). 2020;9(1):32. doi: 10.1186/s13741-020-00164-2
13. Amorim JA, Gomes de, Valença MM. Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia. 2012;32:916–923. doi: 10.1177/0333102412453951
14. Kassa MW, Bedada AG. The Incidence of Post-Dural Puncture Headache and Associated Factors Among Mothers Undergoing Cesarean Section at the Largest Tertiary Teaching Hospital in Botswana. European Journal of Medical and Health Sciences. 2025;7(3):25-31. doi: 10.24018/ejmed.2025.7.3.2301
15. Shaikh JM, Memon A, Memon MA, Khan M. Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25 g Quincke, 27 g Quincke and 27 g Whitacre spinal needles. J Ayub Med Coll Abbottabad. 2008;20(3):10-3. PMID: 19610505.
16. Syed S, Qayoom N, Naaz S, Mushtaq K, Mir AH, Bijli AH, Ali Z. Comparison of post-dural puncture headache- incidence and severity in obstetric patients after spinal anesthesia for caesarean section with 25G and 27G quincke needle. Int J Res Med Sci. 2017;5(2):596-600. doi: 10.18203/2320-6012.ijrms20170158
17. Uppal V, Russell R, Sondekoppam RV, Ansari J, Baber Z, Chen Y, et al. Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group. Reg Anesth Pain Med. 2024;49(7):471-501. doi: 10.1136/rapm-2023-104817
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal and articles are distributed under the terms of the Creative Commons Attribution Non-Commercial Share-Alike License 4.0. This licence allows users to download and share, remix, tweak and build upon the article for non-commercial purposes, so long as the original authorship is acknowledged and the new creations are licensed under identical terms.