Factors Predisposing to Postdural Puncture Headache after Spinal Anaesthesia among Elective Caesarean Section Patients at Thika Level 5 Hospital, Kenya

Abstract

Background: Postdural puncture headache (PDPH) is a common complication following spinal anaesthesia for Caesarean section (CS). There is little data on the incidence and its predisposing factors in low-income countries. The study aimed to investigate the incidence and factors predisposing patients to PDPH after a dural puncture during a planned Caesarean section under spinal anaesthesia at Thika Level 5 Hospital, Kenya. Methods: A cross-sectional study design was used. Pregnant women scheduled for planned Caesarean sections under spinal anaesthesia at Thika Level 5 Hospital were randomly recruited. Data was collected during the fourth quarter of 2021. Patient factors (age, BMI, bed rest, and previous history of PDPH), healthcare provider factors (qualification, experience, and the number of dural punctures), and equipment factors (size, design, and spinal needle orientation) were evaluated to determine predisposing factors for PDPH. Sample size obtained by the use of Fisher’s formula, resulting in a sample size of 103. Results: We found the incidence of PDPH at Thika Level 5 Hospital to be 24.5%. Patient and equipment factors were found to be associated with PDPH. Among the patient factors, high BMI was found to be significant (p = 0.039) while among the equipment factors, traumatic needle tip design (p = 0.049) and the perpendicular orientation of needle bevel (p = 0.022) were found to be associated with PDPH. Conclusion and Recommendations: We conclude that PDPH is a common complication following spinal anaesthesia for Caesarean section, and the incidence (24.5%) is relatively high at Thika Level 5 Hospital. High BMI, traumatic cutting spinal needle tip design and perpendicular orientation of the needle bevel are predisposing factors. Further research is needed to determine the predisposing factors of PDPH at different levels of hospitals in Kiambu County, and understand the specific mechanisms and measures to minimize the incidence PDPH