POSTURAL POSTDURAL PUNCTURE HEADACHE AFTER SPINAL AND EPIDURAL-ANESTHESIA - A RANDOMIZED, DOUBLE-BLIND-STUDY

Background: This study was conducted in order to investigate the effec t of patient expectation in the developement of postural post-dural pu ncture headache (PPDPH). Methods: 224 patients less than 55 years sche duled for minor non-obstetric surgery were randomised to receive singl e-injection spinal (SA) or epidural (EA) anaesthesia. A 27-g Quinke ne edle was used for SA and a 18-g Tuohy needle for EA. Patients, operati ng team and postoperative ward personnel were all blinded to the anaes thetic given and so was an independent observer responsible for follow -up after 5-7 days. The occurrence of headache, backache and other com plaints was recorded. Headache was classified as PPDPH or non-PPDPH, a nd duration and intensity of the headache was registered. The quality of anaesthesia was directly evaluated by the surgeon using a VAS scale from 1 (excellent) to 10 (very poor) and indirectly by the supplement al use of opioid analgesia and general anaesthesia in the two groups. Results: 212 patients, 103 SA and 109 EA, with a mean age of 36.7 year s, could be fully evaluated. The groups were comparable with regards t o age, sex and surgical procedure performed. Headache occurred in 44 p atients postoperatively. PPDPH was diagnosed in 16 patients (15.5%) in the SA group and 2 (1.8%) in the EA group (P=0.0014). Non-PPDPH occur red in 13 patients in each group. PPDPH had significantly greater mean intensity and duration than non-PPDPH. More patients in the EA group had postoperative backache (31.2%) than in the SA group (22.3%), but t his difference was not statistically significant. More patients in the EA received general anaesthesia and opioid analgesia than in the SA g roup, and the surgeon's rating was on average 1.3 in the SA group comp ared to 2.5 in the EA group (P=0.0003). Conclusions: SA gave more head ache but superior quality of surgical anaesthesia compared with EA. Du ral puncture, and not expectation, is the major cause of PPDPH.