ANESTH ANALG 1990;70:389-94
389
Incidence and Prediction of Postdural Puncture Headache A Prospective Study of 1021 Spinal Anesthesias Hans Lybecker,
MD,
Jakob T. Mdler,
MD,
Ole May,
LYBECKER H, MQLLER JT, MAY 0, NIELSEN HK. Incidence and prediction of postdural puncture headache: a prospective study of 1021 spinal anesthesias. Anesth Analg 1990;70:389-94.
The incidence of postdural puncture headache (PDPH) was investigated prospectively in 873 consecutive patients undergoing - a total of 1021 spinal anesthesias, and its association to age, sex, needle size, number of attempted dural punctures, needle bevel direction, duration of postoperative recumbency, and previous PDPH was analyzed, Multivariate analysis showed that age (P < O.OOOl), direction of the
Postdural puncture headache (PDPH) is a wellknown complication in procedures in which the dura mater is perforated, including spinal anesthesia and epidural anesthesia with accidental dural puncture. The following factors are thought to influence the incidence of PDPH: (a) age-higher incidence in younger patients (1-11); (b) gender-higher incidence in females (L5,f3-14); (c) needle size-the larger the diameter of the needle, the higher the incidence and the more prolonged and severe the PDPH (1,3,4,6-15); (d) multiple dural punctureshigher incidence associated with increased number of perforations of the dura mater (16); (e) needle bevel direction and relationship to dural fibers-higher incidence if the needle is inserted perpendicularly to the longitudinal dural fibers, thus cutting them instead of separating them (9,17-20); (f) duration of postoperative recumbency-conflicting results indicate questionable relevance of this factor on the incidence of PDPH (11,21-27); and (g) previous history of PDPH-higher incidence in this group (11,26). This study was supported by grants from the Foundation of Kirsten Jensa La Cour and the Foundation for Medical Research in Ringkabing, Ribe, and South Jutland Counties. Received from the Department of Anesthesia, Esbjerg Central Hospital, Esbjerg, Denmark. Accepted for publication November 21, 1989. Address correspondence to Dr. Lybecker, Department of Anesthesiology, Odense University Hospital, DK-5000 Odense C, Denmark. 01990 by the International Anesthesia Research Society
MD,
and Hans K. Nielsen,
MD
bevel of the needle when puncturing the dura mater ( P = 0.022), and a history of previous p ~ ( p =p 0,018) ~ were significant predictors of PDPH. The estimated relation between PDPH,on the one hand, and age and orientation of the bevel, on the other, enables the anesthetist to predict the risk of PDPH and thereby to choose an acceptable age
limit for
anesthesia.
Key Words: ANESTHETIC TECHNIQUES,
SPINAL-headache. COMPLICATIONS, POSTDURAL HEADACHE.
PUNCTURE
The purpose of the present prospective study was to investigate the influence of the above factors on the incidence of PDPH in a series of consecutive patients, during a period of 1 yr.
Patients and Methods The study was approved by the local ethical committee and informed consent was obtained from each patient. Noncooperative patients and patients with senile dementia or migraine were not included in the study. During a period of 1 yr 1021 spinal anesthesias for different types of surgery below the diaphragm were performed in 873 patients at the Central Hospital of Esbjerg. Multivariate relationships were analyzed using the hierarchical log-linear methods applying the backward elimination principle. A P value of
389
Incidence and Prediction of Postdural Puncture Headache A Prospective Study of 1021 Spinal Anesthesias Hans Lybecker,
MD,
Jakob T. Mdler,
MD,
Ole May,
LYBECKER H, MQLLER JT, MAY 0, NIELSEN HK. Incidence and prediction of postdural puncture headache: a prospective study of 1021 spinal anesthesias. Anesth Analg 1990;70:389-94.
The incidence of postdural puncture headache (PDPH) was investigated prospectively in 873 consecutive patients undergoing - a total of 1021 spinal anesthesias, and its association to age, sex, needle size, number of attempted dural punctures, needle bevel direction, duration of postoperative recumbency, and previous PDPH was analyzed, Multivariate analysis showed that age (P < O.OOOl), direction of the
Postdural puncture headache (PDPH) is a wellknown complication in procedures in which the dura mater is perforated, including spinal anesthesia and epidural anesthesia with accidental dural puncture. The following factors are thought to influence the incidence of PDPH: (a) age-higher incidence in younger patients (1-11); (b) gender-higher incidence in females (L5,f3-14); (c) needle size-the larger the diameter of the needle, the higher the incidence and the more prolonged and severe the PDPH (1,3,4,6-15); (d) multiple dural punctureshigher incidence associated with increased number of perforations of the dura mater (16); (e) needle bevel direction and relationship to dural fibers-higher incidence if the needle is inserted perpendicularly to the longitudinal dural fibers, thus cutting them instead of separating them (9,17-20); (f) duration of postoperative recumbency-conflicting results indicate questionable relevance of this factor on the incidence of PDPH (11,21-27); and (g) previous history of PDPH-higher incidence in this group (11,26). This study was supported by grants from the Foundation of Kirsten Jensa La Cour and the Foundation for Medical Research in Ringkabing, Ribe, and South Jutland Counties. Received from the Department of Anesthesia, Esbjerg Central Hospital, Esbjerg, Denmark. Accepted for publication November 21, 1989. Address correspondence to Dr. Lybecker, Department of Anesthesiology, Odense University Hospital, DK-5000 Odense C, Denmark. 01990 by the International Anesthesia Research Society
MD,
and Hans K. Nielsen,
MD
bevel of the needle when puncturing the dura mater ( P = 0.022), and a history of previous p ~ ( p =p 0,018) ~ were significant predictors of PDPH. The estimated relation between PDPH,on the one hand, and age and orientation of the bevel, on the other, enables the anesthetist to predict the risk of PDPH and thereby to choose an acceptable age
limit for
anesthesia.
Key Words: ANESTHETIC TECHNIQUES,
SPINAL-headache. COMPLICATIONS, POSTDURAL HEADACHE.
PUNCTURE
The purpose of the present prospective study was to investigate the influence of the above factors on the incidence of PDPH in a series of consecutive patients, during a period of 1 yr.
Patients and Methods The study was approved by the local ethical committee and informed consent was obtained from each patient. Noncooperative patients and patients with senile dementia or migraine were not included in the study. During a period of 1 yr 1021 spinal anesthesias for different types of surgery below the diaphragm were performed in 873 patients at the Central Hospital of Esbjerg. Multivariate relationships were analyzed using the hierarchical log-linear methods applying the backward elimination principle. A P value of
