Background: Post-dural puncture headache (PDPH) is a common and often disabling complication associated with spinal anaesthesia. It is mainly influenced by factors such as the patient’s age, sex, and the size and design of the spinal needle used during the procedure. PDPH usually presents as a severe, positional headache that can significantly impair mobility and hinder daily activities, thereby affecting postoperative recovery and overall patient well-being. Understanding how these risk factors interact is vital for developing preventive strategies and optimising anaesthetic techniques to minimise the occurrence of PDPH.

Objective: This study aimed to evaluate the incidence and risk factors for post-dural puncture headache (PDPH) among patients undergoing spinal anaesthesia in the Operating Theatre and Postoperative Recovery Area of SRM Medical College Hospital and Research Centre, Kattankulathur, Tamil Nadu, India, between June and August 2024.

 Methods: This observational study was conducted at SRM Medical College Hospital & Research Centre, Kattankulathur, Tamil Nadu, India, with approval from the Institutional Ethics Committee (IEC No. ST0723-812). A total of 239 adult patients who underwent surgical procedures under spinal anaesthesia between June and August 2024 were included. The study aimed to assess the incidence of post-dural puncture headache (PDPH) and identify associated risk factors. Data were collected from patient records and postoperative assessments. Variables analysed included age, gender, body mass index (BMI), history of headaches, prior PDPH episodes, patient positioning during spinal anaesthesia, number of puncture attempts, and the type and gauge of spinal needle used. The study also examined the type and severity of PDPH and the medications used for its management. Descriptive statistics were used to calculate the incidence of PDPH, while inferential statistical tests, including chi-square, t-test, and logistic regression, were employed to explore the relationship between risk factors and PDPH occurrence, with significance set at p < 0.05.

This observational study was approved by the institutional ethics committee (IEC no. ST0723-812) and included 239 adult patients who underwent surgical procedures under spinal anaesthesia and developed post-dural puncture headache (PDPH). The study examined the incidence of PDPH and explored risk factors, including age, gender, body mass index (BMI), history of headaches, prior PDPH episodes, patient position, number of attempts, needle type and size, headache type, PDPH severity, and medications used to mitigate PDPH.

Result: In this study, the overall incidence of post-dural puncture headache (PDPH) was 12.5%. Most PDPH cases occurred within the first 72 hours after spinal anaesthesia, with a gradual decline in frequency after 42 hours (p < 0.05). A significant association was found between the type of spinal needle used and the incidence of PDPH; patients who received anaesthesia with a 25-gauge Quincke needle had a higher rate of PDPH (p = 0.014). Additionally, the number of needle insertion attempts was significantly linked to PDPH occurrence, with patients undergoing one or two attempts showing a higher incidence than those with three attempts (p = 0.004). In contrast, demographic variables such as age and gender, along with surgical factors including prior history of PDPH, patient positioning during the procedure, and needle type, did not show a statistically significant relationship with PDPH incidence.

Conclusion: This study showed that using smaller-gauge spinal needles significantly reduces the incidence of post-dural puncture headache (PDPH) compared with larger cutting needles such as the Quincke type. Frequent lumbar puncture attempts and increased cerebrospinal fluid (CSF) leakage were also identified as contributing factors to PDPH. Based on these results, clinicians are advised to use smaller spinal needles to reduce CSF leakage and to minimise the number of puncture attempts during spinal anaesthesia and lumbar puncture procedures. These measures may help reduce the risk of PDPH and enhance postoperative patient comfort and outcomes.