Incidence of postdural puncture headache with median and paramedian approach in caesarian section- A Comparative Study

Spinal anaesthesia remains one of the basic techniquesin the arsenal of the modernanaesthesiologist despite the waxing and waning of itspopularity over the 100 years since its introduction in to clinicalpractice.

 Spinal anaesthesia is used extensively for lower abdominaland lower extremitysurgeries because it has distinctadvantages over generalanaesthesia, minimumphysiological disturbance resulting in minimum stress response, optimal operativeconditions, minimal intraoperative blood loss and less postoperative morbidity, it is oftenassociated with significant adverse effects like hypotension, bradycardia and post dural puncture headache (PDPH).

 Ever since itsadvent, the spread of popularity of spinal anaesthesia has to someextent, been checked by the complications of PDPH.

 Post dural puncture headachewas first documented by German surgeon

 August Bier in 1899. Bier also gained firstâ€handexperience of the disabling headache relatedto dural puncture. Headache and backache are the dominant symptoms that develop after post dural puncture. Ninetyper cent of headaches will occur within 2-3 daysof the procedure.

 Headache is the predominant and described as severe,‘searing and spreading like hot metal1’.The common distribution is over the frontaland occipital areas radiating to the neck and shoulders. The temporal, vertex and nuchal areas are reported less commonly as the site of discomfort, although neck stiffness may be

present. The pain is exacerbated by head movement, and adoption of theupright posture, and relieved by lying down.

 There are many factors that influence its development:Age, sex, ambulation, pregnancy,hydration, needle size and design, bevel direction, number of punctures and approach – median and paramedian.

 Though much work has been done on needle size anddesign, less information is available on needle approach and its relation to PDPH2,3.

 Since prevention isbetter than cure, proper selection of the technique can yieldsatisfactory and admirable results in a very large proportion of cases and can provide satisfaction to all concerned.