The incidence of post dural puncture headache in Taiwanese patients undergoing cesarean section

In Taiwan, there was only a retrospective study about the post-dural puncture headache (PDPH) resulting from spinal anesthesia for cesarean section (C/S), but it did not mention the relationship between the incidence of PDPH and the number of dural punctures, as well as between the gauge of spinal needle. Therefore, we designed a prospective study to investigate if the spinal needles for smaller gauges could decrease the incidence of PDPH in anesthesia for C/S.

From Jan. 1990 to June 1991 we prospectively observed 2,385 consecutive cases of spinal anesthesia for various types of surgical procedures, of which 584 were C/S. The spinal needles used were of gauges 24, 25 and 26. In practice, needles of these gauges were randomly applied. The PDPH was observed until its disappearance, and nonexistence of PDPH was also followed for at least one week. All of the data were analyzed using the Fisher exact test.

The overall incidence of PDPH was 1.18%. The incidence of PDPH in C/S females was 3.08%, which was significantly higher than that in non-obstetric females (0.37%). Although the incidence in all females (1.31%) was significantly higher than that in males (0.71%), the incidence in non-obstetric females (0.37%) did not differ significantly compared with males. The incidence of PDPH relevant to the gauges of spinal needle used was not statistically different in C/S females.

It appears that the incidence of PDPH does not differ between Taiwanese and Westerners. Pregnancy may be the key factor contributing to higher incidence of PDPH. The 26-gauge spinal needle may lower the incidence of PDPH to a greatest extent in C/S patients, although in comparison with 24- and 25-gauge needles the difference is not statistically significant.