INCIDENCE AND FACTORS ASSOCIATED WITH POST SPINAL PUNCTURE HEADACHE (PSPH) IN OBSTETRIC MOTHERS WHO UNDERWENT SPINAL ANESTHESIA: A PROSPECTIVE COHORT STUDY
Main Article Content
Keywords
Post spinal puncture headache (PSPH), Spinal anesthesia, Headache
Abstract
Aim- The aim of this study was assessed the incidence and factors associated with postspinal headache in obstetric patients.
Methods-
A prospective cohort study was done on 292 consecutively enrolled obstetric patients at Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan from August 2017 to November 2020. Pretested questionnaires were used to obtain the data needed for analysis. The data were entered into Microsoft Excel, coded, and computer IBM- SPSS Version 26 software for further statistical analysis. Descriptive statistics was used to determine the incidence of postspinal headache.
Results-
The overall incidence of postspinal headache was 39.72%. Factors with higher odds of developing postspinal headache included, Women with a Lower Body mass index (BMI) has been shown to be associated with higher risk of PSPH (.32+.467, t value 11.662, p= 0.000), undergoing 2 puncture attempts (.15+.355, t value 7.089, p =0.000),3 puncture attempts (.51+.501, t value 17.294, p =0.000), and >3 puncture attempts (.32+.467, t value 11.662, p =0.000), a level of puncture entry at L3-4 (.43+.496, t value 14.862, p =0.000) had lower odds of developing PSH, initiation of ambulation >24 h after spinal anesthesia (.46+.499, t value 15.602, p=0.000),cutting needle (.69+.463, t value 25.556, p=0.000), allowing 2-3 drops of cerebrospinal fluid (CSF) to fall (.73+.447, t value 27.770, p=0.000),having lost >1500 ml of blood intraoperatively (.47+.500,t value 15.928, p=0.000), having a previous history of chronic headache (.57+.496, t value 19.580, p=0.000), and those prescribed weak opioids (.91+.285, t value 54.563, p=0.000),
Conclusions-
This was significantly associated with needle design, amount of cerebro-spinal fluid lost, body mass index (BMI), number of puncture attempts, time at start of ambulation, amount of intraoperative blood loss, level of puncture entry, previous diagnosis with chronic headache, and class of analgesic prescribed. We recommend the use of a smaller gauge needle, preventing CSF loss, deliberate attempts to ensure successful puncture with fewer attempts, puncture attempts at L3-4, reducing intraoperative blood loss, earlier ambulation, and prescribing adequate analgesia to reduce the incidence of postspinal headache.
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Dr Nikita Verma
Senior Resident, Hospital - Chhindwara Institute of Medical Sciences, Chhindwara (M.P)
Dr. V.K Parashar
Honorary Consultant, Department of Anaestheriology Critical Care, Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, Jaipur, Rajasthan