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.
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.
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.
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.
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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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.
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 was obtained from all patients for being included in the study.
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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).
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
- spinal anesthesia
- post-dural puncture headache
- knee arthroscopy