A Retrospective Study of Postdural Puncture Headache after Spinal Anesthesia for Cesarean Section Treated by Epidural Blood Patch: Incidence and Associated Factors
Ladda Permpolprasert BNS1, Phongthara Vichitvejpaisal MD, PHD1, Saowapark Chumpathong MD1, Pattrapun Wongsripuemtet MD1
Affiliation : 1 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To investigate the incidence and characteristics of postdural puncture headache [PDPH] requiring epidural blood
patch in patients undergoing cesarean section under spinal anesthesia and find out factors associated with early PDPH onset
and peak PDPH.
Materials and Methods : This descriptive, retrospective study included patients who received spinal anesthesia for cesarean
section and developed PDPH requiring treatment with epidural blood patch during a study period from January 2006 to July
2017. PDPH was diagnosed by an obstetric anesthesiologist. Collected data included demographic characteristics; types and
sizes of spinal needles; PDPH features; spinal needle approach techniques (paramedian or midline approach); number of
lumbar puncture attempts; operator experience levels; conservative treatment, volume of blood administered through an
epidural space, and length of hospital stay.
Results : From a total of 35,290 parturients 77 patients who developed PDPH and required treatment with epidural blood
patch were identified. Parturients had a mean age of 30.6+4.7 years, and a mean BMI of 27.8+6.0 kg/m2. Most patients had
the following features: PDPH occurring in both the occipital and frontal area (66.2%); receiving first attempt maneuver
(58.1%); using 26 gauge (G) Quincke spinal needle (42.9%); and, being performed by 2nd-year resident (39.0%). Patients
undergoing epidural blood patch had a mean length of hospital stay of 5.79+2.5 days, with a mean volume of blood
administered through an epidural space of 13.08+3.5 mL. The association between early onset (0 to 1 postoperative day) or
early peak (0 to 2 postoperative day) of PDPH and the investigated factors did not reach statistically significant level.
Conclusion : Of 35,290 parturients who underwent spinal anesthesia for cesarean section, 77 patients (0.2%) developed
PDPH requiring treatment with epidural blood patch. No investigated factors were found to be significantly associated with
PDPH onset or peak PDPH.
Keywords : Postdural puncture headache, Spinal anesthesia, Cesarean section, Epidural blood patch
