A RANDOMIZED STUDY TO ASSES THE EFFECT OF POSITION DURING INDUCTION OF SPINAL ANAESTHESIA ON INCIDENCE OF POSTDURAL PUNCTURE HEADACHE AFTER ELECTIVE CAESAREAN SECTION IN ADULT PARTURIENT.

Abstract

Background: SA for CS conveys significant advantages over epidural anaesthesia as it is simple to use,
with complete motor relaxation and faster onset, which allows regional anaesthesia in emergency cases
reducing the requirement for GA. SA can usually be administered either in sitting or lateral position. Each
of the positions has advantages and disadvantages. Objective: To compare the the incidence and severity of
post dural puncture headache (PDPH) among pregnant women based on the different positions while
induction of Spinal Anaesthesia with 2 ml 0.5% hyperbaric Bupivacaine. Methodology: The present
randomized control trail was carried out by the department of Anaesthesiology at JSS Medical College and
Hospital Mysuru from November 2017 to June 2019. All the Parturient who were classified based on the
American Society of Anesthesiologists (ASA) Physical status Class II, who were scheduled to undergo
elective caesarean section under Sub Arachnoid Block (SAB), who fulfilled the inclusion criteria were
included in the study. A total of 63 parturient had to be included in each of the groups in the study to detect
a significant relation between position for induction of spinal anesthesia and occurrence of PDPH. Total of
140 parturient, 70 in each group to compensate for drop-outs, were included to detect a difference between
the 2 groups with an alpha error of 0.05 and a power of 0.8. Results: The demographic profile and baseline
vitals were similar in both the groups. Parturient comfort level during positioning for induction of spinal
anesthesia was assessed and it didn’t show any significant difference (p= 0.7). That induction position for
spinal anaesthesia doesn’t affect the incidence of PDPH and null hypothesis was accepted. Conclusion: We
started with the alternate hypothesis that induction of spinal anaesthesia in sitting position causes more
postural puncture headache than when administered in lateral position. However, it was found that
induction position for spinal anaesthesia doesn’t affect the incidence and severity of postural puncture
headache (PDPH).