Magnitude and associated factors of post-dural puncture headache in surgical patients after spinal anaesthesia at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Post-dural puncture headache (PDPH) is a frequent complication following Spinal anesthesia with global incidence rates ranging from 0.3% to 40%, influenced by patient characteristics, clinician expertise and the type of equipment used. Although the use of spinal anesthesia is increasing at Moi Teaching and Referral Hospital (MTRH), local data on the occurrence and management of PDPH is limited. Therefore, understanding its incidence and associated risk factors is essential for improving care and outcomes. Objectives: To determine the incidence, risk factors and management strategies of PDPH among patients receiving spinal anesthesia at MTRH. Methods: This prospective observational study included 198 participants (aged 18 and above) who underwent surgery under spinal anesthesia at MTRH between August 2022 and January 2023. A standard G25 Quincke spinal needle was used in this study. Patients were recruited using a systematic sampling technique and followed at 24hrs, 48hrs, 72hrs, 7 days and 30 days post-procedure. Data on demographics, onset of headache and treatment were collected through patient interviews and review of medical records to complete a structured questionnaire. Analysis was performed using R software (version 4.0.0), with statistical significance set at p<0.05. Results: Participants’ age ranged from 18-63 years with a mean of 31.2(±9.9), with females comprising 72.7% of the sample. The overall incidence of PDPH was 23.7% (95% CI: 17.8-30.4), with most cases (65.9%) occurring within the first 24 hours post-surgery. 38.5% of patients experienced severe symptoms while 31.8% reported moderate symptoms. A significant association was found between PDPH and the number of puncture attempts factor (p = 0.029). Although Male gender (p=0.519) and alcohol use (p=0.068) were noted, they were not statistically significant. Most affected patients (81.8%) required analgesics, with Nonsteroidal anti-inflammatory drugs (NSAIDs) being the most commonly used treatment (43.2%). No epidural blood patches were performed during the study period. Conclusion: PDPH is a common and clinically significant complication after spinal anesthesia at MTRH. The number of needle insertion attempts was a key risk factor in this study. NSAIDs were the primary mode of treatment, with no use of more advanced interventions like Epidural blood patch or nerve blocks. Recommendations: Enhanced training for anesthesia providers is essential to minimize multiple puncture attempts. More research is required on risk factors associated with PDPH. MTRH should adopt a standardized PDPH management protocol, potentially incorporating combination therapies and exploring advanced techniques like epidural blood patches and nerve blocks. Further research into newer treatment options with better efficacy is encouraged.