Cerebrospinal fluid loss at lumbar puncture for caesarean section: any effect on post-dural puncture headache?

Abstract

Background Post dural puncture headache (PDPH) is an unpleasant complication of spinal anaesthesia. Several studies have attempted explanation of its pathophysiology. A widely held view is that it results from loss of cerebrospinal fluid volume resulting from leak following a hole left in the dura after the puncture. The objective of the study was to find out whether this headache results from cerebrospinal fluid lost at induction of spinal anaesthesia.
Methods Ninety parturients of American Society of Anesthetists classes I and II booked for elective Caesarean section were randomised into two groups of forty-five each. In group A, spinal anaesthesia was instituted with 25G Quincke type needle without allowing any cerebrospinal fluid to drop. In group B, five drops of cerebrospinal fluid were allowed before induction. The parturients were followed up for postdural puncture headache.
Results Eighty seven parturients, 45 in group A (no CSF drop) and forty two in group B (CSF drop), completed the study. Three (6.7%) had PDPH in group A and 3 (7.1%) in group B. The mean incidence was 6.9% (OR=1.077, 0.205 – 5.656).
Conclusion The loss of cerebrospinal fluid volume at institution of spinal anaesthesia may not contribute to the development of post-dural puncture headache.

Keywords Post-dural puncture headache, cerebrospinal fluid
loss, spinal anaesthesia