Post dural puncture headache after spinal anesthesia in orthopaedic patients, using 25 gauge quincke - babock spinal needles

ABSTRACT

To find out the frequency of Post Dural Puncture Headache in patients under going for ortho-paedic lower limb surgery with 25 Gauge Quincke spinal needle in patients ranging from 18 to 40 years of age. In the previous studies the incidence was high as more then 8%. Cross-sectional study. This study was conducted in orthopaedic operation theatre and ward of Abbasi Shaheed Hospital, from January, 2004 to July 2005. A total of 200 patients were included in study with ASA I, li III. Both male and female were included in equal proportions. All patients both male and female ranging from 18-45 years of age were included. To assess the Post Dural Puncture Headache a questionnaire was filled on 2[nd] 4[th] and 7[th] post operative day. Post Dural Puncture Headache assessed by using visual analogue and pain rating scale. Two hundred [200] patients were studied, male and female were in equal proportion. The over all incidence of Post Dural Puncture Headache was 4.5% in our study, which is less than the previousstudies. The Occurence of Post Durai Puncture Headache [4%] in male and [5%] female. All Post Dural Puncture Headache occurred on 2[nd] day of surgery, with maximum duration of 4 - 7 days. Treatment consist of, bed rest, enhanced oral / Intra venous fluid and simple analgesic. No patient required blood patch. Occurence of Post Dural Puncture Headache is high in young patients with 25 gauge Quincke needle in the previous studies. But in our study the incidence was 4.5%. there are enough that both size and shape of spinal needle tip influenced the incidence of Post Dural Puncture Headache. The frequency of Post Dural Puncture Headache can be reduced by using small gauge cutting needle or pencil point non-cutting needle. The failure rate may be high by using a small gauge Quincke type spinal needle. The technique is some what difficult with cutting spinal needle