INCIDENCE AND RELATED FACTORS OF POST DURAL PUNCTURE HEADACHE IN THE OBSTETRIC POPULATION IN THE NATIONAL REFERRAL HOSPITAL , HONIARA ,SOLOMON ISLANDS.

Key Words: Post Dural Puncture Headache, Caesarean Section, Spinal Anaesthesia,
Spinal Needle, Bloodstained Cerebral Spinal Fluid
Introduction: Spinal anaesthesia is the common method of anaesthesia for ceaserean section.Post dural puncture headache (PDPH) is one of the complications of spinal anaesthesia caused by the puncture of dura and leakage of cerebral spinal fluid(CSF). PDPH can be debilitating for the mother resulting in slow recovery and limited care to the newborn baby.Spinal needle sizes and designs have shown to be significant risk factors for PDPH. The aim of this study is to define the incidences of PDPH and to determine the risk factors amongst our obstetric population.
Method: This study is a Prospective Descriptive Study conducted on 176 eligible obstetric patients booked for caeserean section under spinal anaesthesia from 7th April to 30th August 2018 in NRH using cutting edge spinal needle sizes 25G and 26G..The datas that were collected were analysed using Epi info.Test of assocaition was done using Fisher’s Exact Test and Risk ratio was also calculated for the variables.A P-value < 0.05 is considered statistically significant.
Results: The overall incidence of PDPH is 7.39 % (13/176).The only factor that has significant association with PDPH is the Bloodstained CSF (p-value 0.01) eventhough literatures do not consider it as a risk factor.Bloodstained CSF increased the risk of developing PDPH 4 times than those who do not have blood stained CSF. Majority of patients who had bloodstained CSF had multiple spinal attempt.The association between bloodstained CSF and PDPH could be due to the multiple traumatic attempt from the cutting edge spinal needle.Eventhough the association between the needle size and PDPH is not significant,it showed that majority of patients who had PDPH were those ones that had the larger spinal needle-25G .
Discussion: Early patient discharged with no follow up,poor documentation and unequal distribution of the spinal needle sizes were some of the significant limitation of this study.This study shows that PDPH is present in our obsteric population. Eventhough the incidence is lower than other similar studies,it is significant for our obstetric patients.This will help us improve our standard of care and practice.Blood stained CSF is a risk factor for PDPH,however further study on this is suggested to findout its significance.