Postdural puncture headache (PDPH) is a common but debilitating complication following dural puncture from spinal/ epidural anaesthesia or from procedures involving dural puncture. Several risk factors have been implicated in its causation. In environments where the economy of anaesthetic practice is important in considering the type of anaesthesia and the limitations in accessing the ideal devices for the maximum comfort of the patient, it is imperative to define any identified risk factor that may contribute to the causation of PDPH. In this study, we indirectly randomized the patients undergoing spinal anaesthesia for cervical cerclage using low doses of heavy bupivacaine and advised all the parturients to remain in bed after the procedure. 62 parturients who had single shot spinal anaesthesia for elective cervical cerclage at a fertility Centre were involved in the study. 29 (46.8%) of the parturients mobilized within four hours of instituting spinal anaesthesia and 33 (53.2%) parturients remained in bed for over 12 hours post spinal. For the parturients who mobilized early (within 4 hours), 16 (55.2%) developed PDPH while among those that remained in bed beyond 12 hours, only 7(21%) developed PDPH (P = 0.006). The parturients all shared similar risk factors. This observation adds to the debate of the possibility of the link between early mobilization and the development of PDPH.

1. Reid JA, Thorburn J. editorial 11. Headache after spinal anaesthesia. Br J Anaesth 1991; 67:674-7
2. Gogarten W, Van AH. A century of regional analgesia in obstetrics. Anaesth Analg 2000; 91:773-5
3. Arevalo-Rodriguez I, et al Posture and fluids for preventing post-dural puncture headache Cochrane Database Syst Rev 2016 mar 7;3: CD009199. Doi 10.1002/14651858. CD 009199. Pub3
4. Ostheimer GW, Palahniuk RJ, Shnider SM. Epidural blood patch for post lumbar puncture headache. Anesthesiology 1974; 41:307-8
5. Vandam LD, Dripps RD. Long term follow up of patients who received 10, 098 spinal anaesthetics. Syndrome of decreased intracranial pressure. J AM Med ASS 1956;161:586-91
6. MacArthur C, Lewis M, Knox EG. Accidental dural puncture in obstetric patients and long term symptoms. Br Med J 1992;304:1279-82
7. Turnbull DK, Shepherd DB, Postdural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 2003;91:718-29
8. Fyneface-Ogan S, et al Post-dural puncture headache following caesarean section in Nigerian parturients: A comparison of two spinal needles Nig Postgrad Med J 2006 ; 13: 200-2
9. Fattahi Z et al. Effect of ondansetron on Post-dural puncture headache(PDPH) in parturients undergoing caesarean section: a double-blind randomised placebo-controlled study J Anaesth 2015; 29: 702-7
10. Dagmar O et al Incidence and Clinical significance of post-dural puncture headache in young orthopaedic patients and parturients. Periodicum Biologonum 2013; 115: 203-208.
11. Carson D, Serpell M. Choosing the best needle for diagnostic lumbar puncture. Neurology 1996;47:33-7
12. Mohammed AD, Ayyuba R, Salisu I et al. An analysis of postdural puncture headache in obstetric patients: A study from Kano Nigeria. Trop J Obst & Gynae 2017;34:16-20
13. Ahsan S, Kitchen N, Jenkins C, Margary J. Incidence of PDPH following spinal anaesthesia for lower segment caesarean section with the 25Gauge polymedic spinal needle. J Pak Med Assc 1996;46:278-81
14. Nafiu OO, Salam RA, Elegbe EO, Postdural puncture headache in obstetric patients: Experience from a West African teaching hospital. Int J Obst Anaes 2007;16:4-7
15. Lubusky M, Berta E, Prochazka M et al. Development of incidence of postdural puncture headache in patients undergoing caesarean section in spinal anaesthesia at the department of obstetrics and gynaecology in Olomouc during 2003-2004. Cas Lek Cesk 2006; 145: 204-8
16. Vilming ST, Schrader H, Monstad I. The significance of age, sex and cerebrospinal fluid pressure in post-lumbar puncture headache. Cephalalgia 1989;9:99-106
17. Kuntz KM, Kokman E, Stevens JC, et al. Postlumbar puncture headaches: experience in 501 consecutive procedures. Neurology 1992; 42:1884-7
18. Park S, Kim K, Park M, Lee U et al Effect of 24-hour bed rest versus early ambulation on headache after spinal anaesthesia: systematic review and meta-analysis Pain Manag Nurs. 2018; 19: 267-276
19. Cook PT, Davies MJ, Bearis RE. Bed rest and PDPH. The effectiveness of 24 hours recumbency in reducing the incidence of PDPH. Anaesthesia 1989; 44: 389-391
20. Fassoulaki A, Sarantopoulos C, Andreopoulou K. Is early mobilization associated with lower incidence of postspinal headache? A controlled trial in 69 urologic patients. Anaesthesiol Reanim 1991; 16:375-8
21. Dawit TAM. Magnitude of postdural puncture headache and associated factors in obstetric mothers undergoing spinal anaesthesia for caesarean section. J of Anaes & Critical care 2019; 11:46-50
22. Tajavanija S, Sithinamsuwan P, Sthinvamuswan N et al. Comparison of prevalence of postdural puncture headache between six hour supine recumbence and early mobilization after lumbar puncture in Thai patients, a randomised controlled study. J Med Ass Thai 2006; 6:814-820.

Otokwala JG

Department of Anaesthesiology, University of Port Harcourt Teaching Hospital, Port Harcourt,  Rivers State, Nigeria