RESEARCH – September 2017

Headache arter neuraxial blockade: prevalence, and associated factors at North Estonia Medical Centre. Prospective cross-sectional study

Authors: Olga Koroljov, Jevgenia Rogozina, Nadežda Smirnova, Aleksandr Koroljov

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Abstract

Background and aims. Postdural puncture headache (PDPH) is thought to be a quite common complication of dural puncture. The incidence of PDPH ranges greatly depending on the patient age and gender, as well as on the needle type and diameter. PDPH impairs the everyday life of the patient considerably and the fear for developing it is believed to be one of the main reasons why patients refuse to undergo neuraxial anaesthesia/analgesia. PDPH can occur after spinal block, diagnostic lumbar puncture and following epidural catheter introduction due to unanticipated dural puncture with a Tuohy needle.

The purpose of the study was to determine and describe the incidence and treatment methods of PDPH in the anaesthesia department of North Estonia Medical Centre. Moreover, the results of the study had to be compared with the results of a similar trial conducted in the same hospital 13 years earlier.

Methods. The patients were randomly recruited into the study during their stay in the recovery unit after an operation undertaken under spinal or epidural anaesthesia and/or if epidural analgesia was used for postoperative pain relief. The recruited patients were actively interviewed at the postoperative days 1, 3, 5 and 7. Every patient had an opportunity to contact the research team by phone. In case PDPH occurred, conservative treatment measures were taken first.

Results. Altogether 379 patients were recruited into the study. The incidence of postoperative headache in the study group was 10.6%. True PDPH was diagnosed in only two cases (0.53%). Association between nonspecific headache and patient age, gender, needle type or diameter was not found.

Conclusion. Headache after neuraxial blockade is believed to occur quite frequently. The current study showed that postoperative headache has multifactorial genesis and dural puncture itself is mostly not the reason for it.