Prone position: A possible method to decrease post dural puncture headache (PDPH) during surgery

Reza Alizadeh; Ziba Aghsaeifard; Bahar Fereydoonnia; Masoud Hashemi; Mojtaba Mostafazadeh

doi:10.1016/j.amsu.2022.103277

Prone position: A possible method to decrease post dural puncture headache (PDPH) during surgery

Ann Med Surg (Lond). 2022 Jan 25:74:103277. doi: 10.1016/j.amsu.2022.103277. eCollection 2022 Feb.

Authors

Reza Alizadeh¹, Ziba Aghsaeifard², Bahar Fereydoonnia¹, Masoud Hashemi³, Mojtaba Mostafazadeh¹

Affiliations

¹ Department of Anesthesiology and Intensive Care, School of Medicine, AJA University of Medical Sciences, Tehran, Iran.
² Department of Internal Medicine, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
³ Anesthesiology Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Objectives: Postdural puncture headache (PDPH) is a complication associated with spinal and epidural anesthesia, characterized by a very severe dull, non-throbbing positional headache along with nausea, vomiting and other symptoms. The aim of this study was to compare positional character of PDPH, where the effects of prone and supine positions during surgery were compared for the risk of the headache.

Methods: This cohort study, was carried out at (XXX) University of Medical Sciences from June 2019 to June 2020 after the approval from the Ethical Committee. 1416 patients participated in this study among whom either supine or prone positions were used for the surgery, based on the type of surgical requirements. All patients received spinal where, 18-gauge cannula was inserted and lactated ringer 4 mL per Kg per hour was used for the administration. Using an aseptic technique, a 26-gauge Quincke needle was inserted intrathecally via a midline approach into the L3-L4 or L4-L5 interspace with the patient in the sitting position. Patients received 10 mg 0.5% hyperbaric bupivacaine. 444 patients were operated in the prone position during surgery (P group) and the 972 patients were in the supine position (S group).

Results: We compared the rate of PDPH between the two groups. 3 (0.68%) patients with pilonidal sinus were operated in prone position experienced headache and 87 of those operated in supine position (8.95%) had headache (P < 0.001); and the odds ratio of developing headache when operated in supine position was 13.16.

Conclusions: Prone position during surgery appears to be a reliable way to reduce PDPH following spinal or epidural anesthesia.

Keywords: CSF, cerebrospinal fluid; Epidural puncture; PDPH, Postdural puncture headache; Postdural puncture headache; Prone position; Spinal anesthesia; Spinal puncture; Supine position.