Evaluation of postdural puncture headache, predisposing factors andmanagement in patients undergoing spinal anaesthesia

Evaluation of Postdural Puncture Headache, Predisposing Factors and Management In Patients Undergoing Spinal Anaesthesia Postdural puncture headache (PDPH) can lead to impaired patient mobilisation, delayed discharge, increased readmission and morbidity. The aim of this study was to investigate the incidence, predisposing factors and treatment of postdural puncture headache after spinal anaesthesia. After ethics committee approval, 399 patients aged 18 years and older, ASA I/II/III, scheduled for elective surgery under spinal anaesthesia were enrolled. Patient demographics, comorbidities, history of headache, type of surgery, spinal anesthesia application technique, needle and local anesthetic characteristics, practitioner experience, application or patient-related factors were recorded. Patients were followed up in the ward until discharge in the postoperative period and on the 3rd and 7th day after discharge by telephone. Mobilisation time, length of hospital stay and amount of fluid given were also recorded. Treatment protocols used in patients who developed PDPH and treatment success were analysed. The incidence of postdural puncture headache was %31,1. Predisposing factors for PDPH included younger age, female gender, co-morbidity, hypertension, previous history of headache, obstetric patients, multiple lumbar punctures and paramedian intervention (p<0.05). No significant relationship was observed between body mass index, needle diameter, local anaesthetic baricity, adjuvants used, procedure position, level of intervention and practitioner experience with PDPH (p>0.05). Referring unsuccessful neuraxial procedures to experienced practitioners resulted in no association between experience and PDPH. It was observed that conservative, pharmacological treatments were applied to patients diagnosed with PDPH and usually resulted in success. epidural blood patch application was planned in only one patient because of lack of response to treatments, but it was not performed due to the patient's refusal. Treatment was successful in 119 (%95.9) of 124 patients with PDPH. With a better understanding of the risk factors for PDPH, it is important for clinicians to be careful when administering spinal anesthesia. We believe that patients should be closely followed up after each neuraxial intervention in order not to delay the treatments to be applied and for early diagnosis. Keywords: Postdural puncture headache, Spinal anesthesia, Epidural blood patch, Neuraxial anesthesia