Title

Cumulative incidence of post dural puncture headache following caesarean section under spinal anaesthesia at The Aga Khan University Hospital Nairobi

Date of Award

7-15-2009

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

Department

Anaesthesia (East Africa)

Abstract

Introduction: Post dural puncture headache can be a debilitating complication of subarachnoid anaesthesia for a new mother. Successful management of post dural puncture headache requires adherence to clear policies and protocols with close follow up of patients by an experienced obstetric anaesthetist.

Objective: This study examined the cumulative incidence and severity of post dural puncture headache in obstetric patients who consented for spinal anaesthesia for caesarean section at the Aga Khan University Hospital, Nairobi.

Study site: The Aga Khan University Hospital, Nairobi.

Study Design: Prospective Cohort study.

Study Population: All women who underwent caesarean sections under spinal anaesthesia and fulfilled the inclusion criteria.

Sample size: One hundred and thirteen (113) women.

Method: Spinal anaesthesia was performed in a hundred and thirteen women undergoing caesarean sections. They were followed up to determine the occurrence of Post Dural Puncture Headache, its severity, onset and duration.

Duration of study: This study that was conducted between January 2009 and April 2009 both months inclusive.

Results: The overall cumulative incidence of post dural puncture headache was found to be 20.35%. In this study, it was shown that the PDPHA was significantly higher in patients in whom the cutting type (Quincke) of needle was used than in those whose spinal anaesthetics were administered using the pencil point needle (80.5% and 19.5% respectively: p = 0.042). None of the other variables assessed had statistically significant correlation with PDPHA.

Conclusion: The incidence of PDPHA at AKUH, Nairobi in women undergoing spinal anaesthesia for caesarean section is higher than the incidences reported in the current literature and significantly related to the needle type used.

Recommendations: The incidence of post dural puncture headache can be significantly reduced in the obstetric population if the pencil point spinal needle was to be routinely used. We also recommend that the use of the Quincke needles should be discouraged due to their statistically significant association with PDPHA.

This document is available in the relevant AKU library

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