Effect of experience with spinal anaesthesia on the development of post-dural puncture complications

This clinical study was conducted in order to investigate the effect of operator experience with spinal anaesthesia (SA) on development of postural post-dural puncture headache (PPDPH) and postoperative backache.

The study was a cohort study of the first 100 SA performed by each of 5 trainees in anaesthesiology at the very beginning of their training period. SA was conducted with assistance and guidance according to usual departmental practice. In each SA, data regarding level of puncture, needle size, number of punctures, use of introducer and infiltration anaesthesia were recorded. In addition, usual problems and complications connected with dural puncture were registered. A visual analogue scale was used to record how difficult the procedure was experienced by the trainees. Postoperatively, the patients were contacted by the same trainee, usually by telephone. A semi-structured interview was conducted where occurrence and duration of headache, backache and other complaints were recorded. Headache was classified as PPDPH or non-PPDPH, and intensity of the headache was registered using a numerical rating scale (NRS) from 0 to 10.

Five hundred SA in 495 patients with a mean age of 61.3 years were included in the study. Of these, 394 patients were completely followed-up postoperatively; the main reason for the drop-out was patient-related factors such as advanced age and dementia. Headache occurred in 56 patients postoperatively. PPDPH was diagnosed in 33 and non-PPDPH occurred in 23 patients. Postoperative backache was experienced by 27 patients. No significant effect experience with SA could be found regarding the occurrence of postoperative complications; 16 compared to 17 patients with PPDPH were found in the first and the last half of patients. A marked inter-individual difference in the occurrence of PPDPH was found in the patients treated by the 5 trainees.

We could not demonstrate an effect of experience and training on development of complications after SA with regard to PPDPH and backache.