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| Name | Class |
|---|---|
| Karnali Academy of Health Sciences | OTHER |
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The aim of this study is to examine the effects of altitude (high altitude versus low altitude) on incidence and severity of postural puncture headache (PDPH) following spinal anaesthesia for caesarean delivery. The investigators hypothesized that the risk of PDPH would be higher in highlander parturients than in lowlander parturients.
This will be a prospective cohort study conducted in two different altitudes in Nepal. The high-altitude site is in Jumla, approximately 2514 m above the sea level, and a low altitude city is Dharan, located at 350 m from sea level.
The investigators will screen the eligible participant admitted to the in-patient obstetric unit. The investigator will also record patient baseline characteristics, preoperative anxiety, antenatal depression, presence of chronic pain conditions or preexisting headache. Spinal anaesthesia will be administered in the sitting position at the L3-L4 or L4-L5 interspace using a 25-G pencil point spinal needle (Pencan® 25-gauge).
The diagnosis of post-dural puncture headache will be based on the international headache society ICDH-3 criteria
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| High-altitude group | Parturient who are native to their resident altitude, i.e. residing at the altitude above 2500 m from sea level will receive spinal anesthesia for caesarean section. | ||
| Low-altitude group | Parturient who are native to their resident altitude, i.e. residing at the altitude below 500 m from sea level will receive spinal anesthesia for caesarean section. |
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| Measure | Description | Time Frame |
|---|---|---|
| Number of patients with postdural puncture headache | The diagnosis of post-dural puncture headache will be based on the international headache society ICDH-3 criteria: a headache that occurs within 5 days of a dural puncture, is located in the occipital and/or frontal areas, worsens within 15 min of sitting or standing and alleviates within 15 min after lying down, associated with at least one of the following features: neck stiffness, nausea, vomiting, photophobia, and tinnitus, and resolves either spontaneously within 1 week or within 48 h after effective treatment. | up to 7 days after spinal anesthesia |
| Measure | Description | Time Frame |
|---|---|---|
| Number of patients with severity of postdural puncture headache | using a numeric rating scale (NRS), with 0= NO pain 10=worst imaginable pain, and classified as none (NRS=0), mild (1-3), moderate (4-6), and severe (7-10) | up to 7 days after spinal anesthesia |
| Number of patients with non-postdural puncture headache |
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Inclusion Criteria:
Exclusion Criteria:
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Parturients planned for elective and non-elective (category 2 & 3) caesarean section under spinal anaesthesia.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Asish Subedi, MD | Contact | 9842040604 | ashish.subedi@bpkihs.edu |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Karnali Academy of Health Sciences | Recruiting | Jumla | Karnali | 2069 | Nepal |
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| ID | Term |
|---|---|
| D051299 | Post-Dural Puncture Headache |
| ID | Term |
|---|---|
| D051271 | Headache Disorders, Secondary |
| D020773 | Headache Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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Headache that is not related to posture |
| up to 7 days after spinal anesthesia |
| Number of patients who received treatment for postdural puncture headache | paracetamol, NSAID's, caffeine, opioids, glossopharyngeal nerve block, sphenopalatine ganglion block and epidural blood patch | up to 1 month after occurrence of PDPH |
| BP Koirala Institute of Health Sciences (BPKIHS) | Recruiting | Dharān | Koshi | 56700 | Nepal |
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| D009422 | Nervous System Diseases |