Risk Factors of Post Dural Puncture Headache in Cesarean Section Patients: A Multivariate Analysis Study

Abstract

Background: The use of spinal anesthesia in patients undergoing cesarean section (CS) is at risk of experiencing post-dural puncture headache (PDPH). This is influenced by several factors. Objective: This study aimed to assess the effect of risk factors on the occurrence of PDPH in patients undergoing CS under spinal anesthesia. Methods: The study design is a nested case-control study with independent variables influencing the incidence of PDPH in CS with spinal anesthesia. Samples were taken from CS patients with spinal anesthesia at the Central Surgical Installation of Dr. Kariadi General Hospital, who met the inclusion and exclusion criteria. Result: A total of 74 patients were included in the multivariate analysis, which showed that neurological disorders with p-value = 0.069; OR= 9,306; 95% CI = 0.842-102.828 and the number of punctures with p = 0.060; OR= 4.798; 95% CI = 0.997-23.075 is the most significant risk factor for the incidence of PDPH in CS patients. There was an additive effect which indicated that mobilization of more than 6 hours mutually reinforces the occurrence of PDPH in CS patients. Conclusion: Preoperative risk factors such as a history of neurological disorders increase the incidence of PDPH in CS patients. Intraoperative risk factors in this study were total puncture and needle size, increasing the incidence of PDPH in CS patients. Post-operative risk factors, in this case, immobilization, increase the incidence of PDPH in CS patients. Preoperative, intraoperative, and post-operative risk factors, together or separately, increase the incidence of PDPH in patients undergoing CS.

Keywords

• cesarean section
• early mobilization
• post-dural puncture headache
• risk of post-dural puncture headache
• risk of spinal anesthesia