Effect of high altitude on the incidence of postdural puncture headache in young males: A 5-year restrospective study

Abstract

Background: Postdural puncture headache (PDPH) is a serious and debilitating complication and a major cause of postoperative morbidity occurring after spinal anesthesia (SA) or inadvertent dural puncture after epidural anesthesia. The understanding of pathophysiology of PDPH has improved over the last few decades and its occurrence is now on decrease with use of better techniques and smaller gauge needles. Over the past several years, many of the risk factors attributable to PDPH have been identified and studied extensively, but only few studies have evaluated the effect of increasing altitude on the occurrence of PDPH. As a significant proportion of population undergo surgery in such elevations, we retrospectively evaluated the effect of high altitude on the incidence of PDPH following SA. Materials and Methods: This study was conducted at a single center, retrospective observational study in the high altitude and cold climate region, for a period of 5 years. The data collected were evaluated for the occurrence of PDPH. Results: The total number of cases undergoing surgery under SA in our center was 440 over a period of 5 years. The cumulative incidence of PDPH in this cohort was 6.6%. The incidence was 7.15% and 5.56% with use of 26G and 27G Quincke needle, respectively, which is higher than that observed in the low-lying areas. Conclusions: The incidence of PDPH is higher in patients undergoing surgery under SA at high altitude.

Keywords

• cerebrospinal fluid leak
• high altitude
• postdural puncture headache
• spinal anesthesia