Postdural Puncture Headache After Spinal Anesthesia for Cesarean Section

The Effect of Glass Particle Contamination From Bupivacaine Ampules on Postdural Puncture Headache After Spinal Anesthesia for Cesarean Section: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Post-dural puncture headache (PDPH) is a potential and debilitating complication of spinal anesthesia in pregnant patients undergoing caesarean sections (CS), with a reported incidence of 0.5%-2% .

Various methods for the management of PDPH are present including proper hydration, maintaining a supine posture, caffeine, paracetamol, nonsteroid anti-inflammatory drugs (NSAID), theophylline, opioids like morphine and fentanyl, with the only clearly effective treatment being the epidural blood patch.

Glass particle contamination is known to occur on opening single-dose drug ampoules. Although supporting data are lacking, intrathecal drug administration during subarachnoid blocks and chemotherapy with glass particle contamination is potentially hazardous,

Inclusion Criteria:

• Parturient with American Society of Anesthesiologists (ASA) class I or II
• Age: 20-45 years old
• A full-term pregnant female undergoing elective cesarean section under spinal anesthesia

Exclusion Criteria:

• Contraindications to regional anesthesia (coagulopathy, infection at the needle insertion site)
• History of Migraines or persistent headache
• Known hypersensitivity to local anesthetics
• Body mass index (BMI > 35 kg/m2)
• Hypertensive disorders of pregnancy
• Emergency cesarean section
• Cardiorespiratory, hepatic, or renal impairment
• History of a cerebrovascular accident, neurologic or psychological disorders
• Uncontrolled hypertension
• Spinal column surgery, chronic opioid consumption
• Patients with more than one single attempt and patients with blood loss over 1000 mL who will need additional fluid supplementation or blood transfusion
• Patient refusal