A RANDOMIZED SINGLE BLINDED STUDY COMPARING THE INCIDENCE OF POST DURAL PUNCTURE HEADACHE AFTER SPINAL ANESTHESIA USING 25 GAUGE WHITACRE NEEDLE WITH MEDIAN AND PARAMEDIAN APPROACH IN CESAREAN SECTION PATIENTS

Abstract

Introduction: Subarachnoid block is the most commonly used anaesthetic technique for
caesarean sections. Post-dural puncture headache (PDPH) is an iatrogenic complication of
spinal anaesthesia. Reported risk factors for PDPH include sex, age, pregnancy, needle tip
shape and size, bevel orientation, approach and others. The aim of this study is to assess the
incidence of postdural puncture headache in the median and paramedian approach using
25G Whitacre spinal needle in pregnant females undergoing caesarean section.
Materials and methods: After obtaining institutional ethical committee approval,100
patients of ASA I and ASAII of pregnant women undergoing caesarean section belonging to
age group of 18-35 years randomized by computer generated numbers into two groups (50
each) after fulfilling inclusion criteria. The patients were randomized to receive spinal
anaesthesia by either a median (n=50) approach or paramedian approach (n=50). After
informed written consent, all patients were premedicated with Inj.Metoclopromide 10mg
and all patients received 500ml of Normal saline intravenously over 30minutes before the
procedure. Each patient received 9-12mg of hyperbaric bupivacaine with 25G Whitacre
spinal needle either through median approach(group M, n=50) or paramedian
approach(group PM, n=50).The patients were followed for 48 hours for PDPH, presence of
PDPH was assessed by visual numerical analogue scale.
Results: Out of total 100 caesarean section patients, six patients developed PDPH. 4/50(8%)
had PDPH in median approach and 2/50(4%) had PDPH in paramedian approach. However
the difference in incidence of PDPH in both median and paramedian approaches is not
statistically significant (p value=0.4000) and the severity of PDPH in both groups was of
mild degree.
Conclusion: Even though we noticed the incidence of PDPH is less with 25G Whitacre spinal needle in paramedian approach compared to median approach, but there was no significant statistical difference on incidence of PDPH using 25 G Whitacre spinal needle between median and paramedian approach in caesarean section patients