Prevalence and Associated Factors of Postural Puncture Headache After Spinal Anesthesia for Cesarean Section at Three Teaching Hospitals in Addis Ababa, Ethiopia; 2024/25 G.C
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Date
2025
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Addis Ababa University
Abstract
Background: - Post-Dural puncture headache (PDPH) is one of the major complications of spinal anesthesia. It occurs in 32% of patients carrying a considerable morbidity. Also, the associated symptoms last for several days, at times severe enough to impair patient’s quality of life. Several risk factors contribute for the development of post-Dural puncture headache which varies with characteristics of individual patients, the type of spinal needle and the technique or approach used.
Objective: - To assess the prevalence and associated factors of post-Dural puncture headache after spinal anesthesia for caesarean section at three teaching hospital in Addis Ababa, Ethiopia.
Method: - An institution based cross-sectional study was conducted at 3 teaching hospitals of Addis Ababa university. Consecutive sampling technique was used to include 904 study participants of post-operative women during the study periods of December 15, 2024 G.C. – May 31, 2025 G.C. The data were coded, entered, and analysed by using SPSS version 25. Descriptive statistics were used to describe the study variables. Logistic regression analysis was used to assess associated factors of post-Dural puncture headache. A p-value of < 0.05 was considered statistically significant.
Results: PDPH was observed in 38.4% of patients (n=347), with the majority reporting a mild headache (76.9%). Most headaches developed within the first 1–2 days post-procedure (72.3%). Associated symptoms included neck stiffness (85.9%) and tinnitus (38.3%). Significant risk factors identified included age ≥35 years (AOR: 2.7), ASA class III status (AOR: 1.9), previous spinal anesthesia (AOR: 3.1), high gravidity (≥5), and emergency cesarean section (AOR: 2.7). Technical factors such as increased number of cerebrospinal fluid drops (AOR for three drops: 3.3) and multiple puncture attempts (AOR for three attempts: 31.6) greatly increased PDPH risk. Procedures performed by residents and anesthesiologists were also associated with higher PDPH incidence.
Conclusion: More than one-third of the study participants developed post-Dural puncture headache (PDPH) following spinal anesthesia. Younger age, previous PDPH, higher gravidity, emergency cesarean section, multiple cerebrospinal fluid drops, repeated puncture attempts, and anesthesia administered by less experienced providers were independently associated with increased risk.
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Key word: incidence, associated factors, post-dural puncture headache, spinal anesthesia, A.A, Ethiopia