Published in:
01-07-2017 | Original Article
Post-Dural Puncture Headache is Uncommon in Young Ambulatory Surgery Patients
Published in: HSS Journal ® | Issue 2/2017
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Background
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.
Questions/Purposes
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.
Methods
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.
Results
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.
Conclusions
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.