Post-Dural Puncture Headache is Uncommon in Young Ambulatory Surgery Patients

Abstract

Background

The incidence of post-dural puncture headache (PDPH) arising from spinal anesthesia in the general population is low. However, patients under 45 years have been shown to exhibit a higher incidence of PDPH, even with small needles.

Questions/Purposes

This study aimed to estimate the incidence of PDPH from a 27G pencil-point needle in ambulatory surgery patients between the ages of 15–45 years and compare incidence of PDPH by age group, sex, and history of headache.

Methods

In this prospective cohort study, 300 patients (15–45 years old) who underwent simple knee arthroscopy under spinal anesthesia with a 27G pencil-point needle were enrolled. Verbal consent was obtained during the initial phone conversation between post-operative days (PODs) 2–5. A PDPH questionnaire was administered during this conversation and between PODs 7–10. Patients who reported a positional headache were contacted by a physician co-investigator, who determined PDPH diagnosis.

Results

Five patients were excluded from analysis due to complicated operative procedures or spinal needle size. The overall PDPH incidence was 2.0% (95% CI 0.9–4.4; 6/295). PDPH incidence in 15–19-year-old patients was 16.7% (95% CI 4.7–44.8; 2/12). The crude relative risk of PDPH was 15.4 (95% CI 2.8–114.4) for patients with and without history of headache and 2.5 (95% CI 0.5–14.8) for females vs. males. Overall, 16.3% (95% CI 12.5–20.9) of patients reported post-operative, non-positional headaches.

Conclusions

There was a low overall incidence of PDPH among patients aged 15–45. Pre-planned subgroup analyses of PDPH incidence by age group revealed a high risk of PDPH among a small sample of 15–19-year-olds.

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References

  1. 1.

    Amorim JA, Gomes de Barros MV, Valenca MM. Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia. 2012; 32(12): 916-23.

    Article  PubMed  Google Scholar 

  2. 2.

    Amorim JA, Valenca MM. Postdural puncture headache is a risk factor for new postdural puncture headache. Cephalalgia. 2008; 28(1): 5-8.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Brattebo G, Wisborg T, Rodt SA. Intrathecal anaesthesia in patients under 45 years: incidence of postdural puncture symptoms after spinal anaesthesia with 27G needles. Acta Anaesthesiol Scand. 1993; 37(6): 545-8.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Clark JW, Solomon GD, Senanayake PD, et al. Substance P concentration and history of headache in relation to postlumbar puncture headache: towards prevention. J Neurol Neurosurg Psychiatry. 1996; 60(6): 681-3.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Despond O, Meuret P, Hemmings G. Postdural puncture headache after spinal anaesthesia in young orthopaedic outpatients using 27-g needles. Can J Anaesth. 1998; 45(11): 1106-9.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Dittmann M, Schaefer HG, Renkl F, et al. Spinal anaesthesia with 29 gauge Quincke point needles and post dural puncture headache in 2,378 patients. Acta Anaesthesiol Scand. 1994; 38(7): 691-3.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Halpern S, Preston R. Postdural puncture headache and spinal needle design. Metaanalyses Anesthesiol. 1994; 81(6): 1376-83.

    CAS  Article  Google Scholar 

  8. 8.

    Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 2nd edition. Cephalalgia. 2004; 24(1): 9-160.

    Google Scholar 

  9. 9.

    Janssens E, Aerssens P, Alliet P, et al. Post-dural puncture headaches in children. A literature review. Eur J Pediatr. 2003; 162(3): 117-21.

    PubMed  Google Scholar 

  10. 10.

    Kuo C, Edwards A, Mazumdar M, et al. Regional anesthesia for children undergoing orthopedic ambulatory surgeries in the United States, 1996–2006. HSS J. 2012; 8(2): 133-6.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Lowery S, Oliver A. Incidence of postdural puncture headache and backache following diagnostic/therapeutic lumbar puncture using a 22G cutting spinal needle, and after introduction of a 25G pencil point spinal needle. Paediatr Anaesth. 2008; 18(3): 230-4.

    Article  PubMed  Google Scholar 

  12. 12.

    Lybecker H, Moller JT, May O, et al. Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias. Anesth Analg. 1990; 70(4): 389-94.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Mosaffa F, Karimi K, Madadi F, et al. Post-dural puncture headache: a comparison between median and paramedian approaches in orthopedic patients. Anesth Pain Med. 2011; 1(2): 66-9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    van de Velde M, Teunkens A, Hanssens M, et al. Post dural puncture headache following combined spinal epidural or epidural anaesthesia in obstetric patients. Anaesth Intensive Care. 2001; 29(6): 595-9.

    PubMed  Google Scholar 

  15. 15.

    Wadud R, Laiq N, Qureshi FA, et al. The frequency of postdural puncture headache in different age groups. J Coll Physicians Surg Pak. 2006; 16(6): 389-92.

    PubMed  Google Scholar 

  16. 16.

    Wu CL, Rowlingson AJ, Cohen SR, et al. Gender and post-dural puncture headache. Anesthesiology. 2006; 105(3): 613-8.

    Article  PubMed  Google Scholar 

  17. 17.

    Wulf HF. The centennial of spinal anesthesia. Anesthesiology. 1998; 89(2): 500-6.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    YaDeau JT, Liguori GA, Zayas VM. The incidence of transient neurologic symptoms after spinal anesthesia with mepivacaine. Anesth Analg. 2005; 101(3): 661-5. Table of contents.

    CAS  Article  PubMed  Google Scholar 

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Correspondence to Kathryn DelPizzo MD.

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Conflict of Interest

Kathryn DelPizzo, MD; Jennifer Cheng, PhD; Naomi Dong, MD; Chris R. Edmonds, MD; Richard L. Kahn, MD; Kara G. Fields, MS; Jodie Curren, BSN, RN; Valeria Rotundo; and Victor M. Zayas, MD have declared that they have no conflict of interest.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was obtained from all patients for being included in the study.

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Disclosure forms provided by the authors are available with the online version of this article.

Funding

This work was supported by the Department of Anesthesiology at Hospital for Special Surgery, and REDCap was funded by the National Center for Advancing Translational Science of the National Institutes of Health (UL1TR000457; REDCap use).

Additional information

Level of Evidence: Prognostic study, Level II

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DelPizzo, K., Cheng, J., Dong, N. et al. Post-Dural Puncture Headache is Uncommon in Young Ambulatory Surgery Patients. HSS Jrnl 13, 146–151 (2017). https://doi.org/10.1007/s11420-017-9541-0

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Keywords

  • spinal anesthesia
  • post-dural puncture headache
  • knee arthroscopy
  • complications