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Caesarean Section with Spinal Anesthesia and Postspinal Headache

Mine Genç, Nur Sahin, Jale Maral, Esin Celik, Afife Aysun Kar, Pınar Usar, Berrin Korkut, Serkan Guclu


Purpose: To find out ‘what is the leading cause of postpartum headache in patients undergoing caesarean section with spinal anesthesia under elective conditions?’

Methods: Our study was conducted with retrospective, controlled assessment of 304 patients who underwent caesarean section with spinal anesthesia under elective conditions at our institution between 1 June 2012 and 1 November 2012. The patients were assessed in terms of postpartum headache. They were divided into 2 groups: the group with headache versus the group without headache (the latter was the control group). Both groups were compared with respect to age, body mass index (BMI), number of previous pregnancies, indications for caesarean section, the spinal needle used during spinal anesthesia, preoperative and postoperative amount of fluid administration, and mobilization time.

Results: None of the factors that are effective in development of headache, i.e. age, multiparity, the indication for caesarean section, BMI, and needle type, was statistically significant in logistic regression analysis. Only the needle type was significantly related to headache in Chi-Square test. All headache episodes were mild and improved with conservative therapy. We did not find any difference between groups with respect to age, BMI, number of previous pregnancies, indications for caesarean section, preoperative and postoperative amount of fluid administration, and mobilization time.

Conclusion: In patients undergoing cesarean section with spinal anesthesia under elective conditions the main cause of headache is the type of the spinal needle used.


caesarean section; headache; spinal anesthesia

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Ranasinghe JS, Steadmann J, Toyama T, Lai M. Combined spinal epidural anaesthesia is better than spinal or epidural alone for Caesarean delivery. British journal of anaesthesia. 2003, 91:299-300

Fauzia B, Saleem S, Safia Z, Nabeela R, Mirza NI, Saeeda H. Intrathecal fentanyl as adjunct to hyper baric bupivacaine in spinal anesthesia for Caesarean Section. JCPSP. 2006, 16:87-90

Erdine S. Rejyonel Anestezi. İstanbul: Nobel Tıp Kitabevleri. 2005, p.159-84

Morgan GE, Mikhail MS, Murray MJ, Larson CP. Regional Anesthesia&Pain Management In: Morgan GE (Ed). Clinical Anesthesiology. 3rd ed. Los Angeles: The McGraw-Hill Companies; 2002, p.253-344

Miller RD. Anesthesia. 4 th ed. New York Churchill Livingstone; 1994, p1505-1533.

Sprigge JS, Harper SJ. Accidental dural puncture and post dural puncture headache in obstetric anaesthesia: presentation and management: A 23-year survey in a district hospital. Anaesthesia. 2008, 63:36-43

Van Kooten F, Oedit R, Bakker SLM, Dippel DWJ. Epidural blood patch in postdural puncture headache: a randomised, observer-blind, controlled clinical trial. J Neurol Neurosurg Psychiatry. 2008, 79:553-558

Herbert C. Spencer Postural Puncture Headache: WhatMatters in Technique. Regional Anesthesia and Pain Medicine. 1998, 23:374-376

Halpern S, Preston R. Postdural puncture headache and spinal needle design. Meta analyses. Anesthesiology. 1994, 81:1376-1383

Cooney CM, Tarpey J. Postdural puncture headache. British Journal of Anaesthesia. 1992, 68:637

Zeidan A, Farhat O, Maaliki H, Baraka A. Does postdural puncture headache letf untreated lesd to subdural hematoma? Case report and reviev of the literatüre. Int J Obstet Anesth. 2006, 15:50-58

Ready LB, Cuplin S, Haschke RH, Nessly M. Spinal needle determinants of rate of transdural fluid leak. Anesth Analg. 1989, 69:457-460

Lynch J, Kasper SM, Strick K, Topalidis K, Schaaf H, Zech D, Krings-Ernst I. Theuse of Quincke and Whitacre 27-gauge needles in orthopedic patients: incidence of failed spinal anesthesia and postdural puncture headache. Anesth Analg. 1994, 79:124-128

Reid F, Thorburn J. Headache after spinal anaesthesia. British Journal of Anaesthesia. 1991, 67:674-676

Garry M, Davies S. Failure of regional blockade for Caesarean section. Int J Obstet Anesth. 2002 , 11:9-12

Katı İ, Demirel C, Abbasov Ü, Silay E, Coşkuner İ, Tokmak Y. İğne tipinin spinal anestezi komplikasyonları üzerine etkileri. Van Tıp Dergisi. 2002, 9:47-51

Lynch J, Krings-Ernst I, Strick K, Topalidis K, Schaaf H, Fiebig M. Use of a 25-gauge Whitacre needle to reduce the incidence of postdural puncture headache. British Journal of Anaesthesia. 1991, 67:690-693

Sharma s, gambling D, Joshi G, Sidawi J. Comparison of 26-gauge Atrocan and Whitacre needles: insertion characteristics and complications. Canadian Journal of Anaesthesia. 1995, 42:706-707

Lavi R, Rowe JM, Avivi I. Lumbarpuncture: it is time to change the needle. EurNeurol. 2010, 64:108- 113

Hammond ER, Wang Z, Bhulani N et al. Needle type and the risk of post-lumbar puncture headache in the out patient neurology clinic. J Neurol Sci. 2011, 306: 24- 28

Kim JH, Song SY, Kim BJ. Predicting the difficulty in performing a neuraxial blockade. Korean J Anesthesiol. 2011, 61:377-381

Kuntz KM, Kokmen E, Stevens JC et al. Post-lumbar puncture headaches: experience in 501 consecutive procedures. Neurology. 1992, 42:1884 - 1887

Frenkel C, Altscher T, Groben V, Hörnchen U. Theincidence of post spinal headache in a group of young patients. German Anaesthesist. 1992, 41:142-145

Rodriques AM, Roy PM. Post-lumbar puncture headache. France Rev Prat. 2007, 57:353-357

Fassoulaki A, Sarantopoulos C, Andreopoulou K. Is early mobilization associated with lower incidence of post spinal headache? A controlledtrial in 69 urologicpatients. Greece Anaesthesiol Reanim. 1991, 16:375-378

Andersen AP, Wanscher MC, Hüttel MS. Post spinal headache. Is 24-hour flat bed rest a preventive measure? German Reg Anaesth. 1986, 9:15-17

Basurto Ona X, Martínez García L, Solà I et al. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev nr. 2011, 2: CD007887

Sandesc D, Lupei M ‐ I, Sirbu C. et al. Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. Acta Anaesthesiol Belg. 2005, 56:265-269


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