Incidence and associated factors of post dural puncture headache in cesarean section done under spinal anesthesia 2021 institutional based prospective single-armed cohort study.

BACKGROUND

Spinal anesthesia is the most commonly used anesthesia technique for Cesarean delivery with 80%-95% prevalence. The most common complication of SA is post-dural puncture Headache which is associated with dural puncture & Cerebrospinal fluid leak. This study aimed to assess the incidence and associated factors of post-dural puncture headache.

METHODS

single-armed cohort study design was employed on 412 women from May 2021 to January 2022. Study subjects were selected using systematic random sampling. Descriptive statistics for each variable, binary logistic regression, and multiple logistic regression analysis with 95% CI was carried out.

RESULTS

The overall incidence of post-dural puncture headache in this study was 25.7%. 43.9% of Post dural headache was detected in the 1st 24 h followed by 48 h. Of those who develop Post-dural headaches, 54.1% of them had mild pain, 17.3% of them was moderate pain and 28.6% of them suffered severe pain. The multivariable analysis indicated that BMI>30 kg/m2 [AOR 2.85 95% CI: 1.91-4.25], number of attempts (>3), (AOR = 1.5, 95% CI: 1.19-1.91), and cephalic needle direction (AOR = 5.79 95% CI: 2.27-12.22), were factors associated with increased post-dural puncture headache. While large gauge needle size (AOR = 0.28 95% CI: 0.19-0.42), and greater than 3 years of experience of anesthetist (AOR = 0.44, 95% CI: 0.31-0.62) were associated with decreased incidence of post-dural puncture headache.

CONCLUSION

The incidence of post-dural puncture headache was higher in BMI>30 kg/m2, greater than 3-time attempts during spinal anesthesia, using low gauge spinal needles, less than 3 years of experience as anesthetist and cephalic needle direction.