Efficacy of prophylactic epidural saline for reducing postdural puncture headache in patients undergoing caesarean section





Postdural Puncture Headache, Epidural saline, Spinal anesthesia, Cesarean section


Aim: Post-Dural Puncture Headache (PDPH) is a common complication of spinal anesthesia during the postoperative period. The optimal means of prevention, management, and treatment of this disorder are uncertain. The objective of this current study was to investigate the effect of a 24 hours-continuous infusion of saline on the occurrence of PDPH in patients undergoing caesarean section and to provide a reference for the clinical prevention of PDPH.

Methods: This study included 126 patients aged between 18 and 45 years with an American Society of Anesthesiology physical status (ASA) score of 1-2, who underwent elective caesarean operation. Patients were randomized into control (n=63) and study groups (n=63). Spinal anesthesia was administered to both groups via a 27-gauche spinal needle. The study group was administered normal saline infusion for 24 hours with an easy-pump device through an epidural catheter. 

Results: Seven control-group patients developed PDPH within the first 72 hours postoperatively while it was not observed in any of the study-group patients. Visual analogue scale and numerical rating scales were used for pain measurement. Five patients described mild pain while two described moderate pain. Severe headache was not observed in any patients at any time.

Conclusion: This study demonstrated that the administration of epidural saline during an elective caesarean under spinal anesthesia significantly reduced the incidence of PDPH and was not associated with any side-effects.


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Haller G, Cornet J, Boldi MO, Myers C, Savoldelli G, Kern C. Risk factors for post-dural puncture headache following injury of the dural membrane:a root-cause analysis and nested case-control study. Int J Obstet Anesth. 2018;36:17-27.

Morgan GE, Mikhail MS, Murray MJ, Larson CP. Regional Anesthesia&Pain Management In:Morgan GE (Ed). Clinical Anesthesiology. 3rd ed. Los Angeles:The McGraw-Hill Companies;2002;253-344.

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1‐211.

Bezov D, Lipton RB, Ashina S. Post‐dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache. 2010;50:1144–52.

Wu C, Lian Y, Guan D. A multicenter clinical study on treating post-dural puncture headache with an intravenous injection of aminophylline. Pain Physician. 2016;19:E761–65.

Choi JS, Chang SJ. A comparison of the incidence of post-dural puncture headache and backache after spinal anesthesia:a pragmatic randomized controlled trial. Worldviews Evid Based Nurs. 2018;15:45–53.

DiGiovanni AJ, Dunbar BS. Epidural injections of autologous blood for postlumbarpuncture headache. Anesth Analg. 1970;49:268-71.

Arevalo-Rodriguez I, Muñoz L, Godoy-Casasbuenas N, Ciapponi A, Arevalo JJ, Boogaard S, Roqué I, Figuls M. Needle gauge and tip designs for preventing post-dural puncture headache (PDPH). Cochrane Database Syst Rev. 2017;7:CD010807.

Bradbury CL, Singh SI, Badder SR, Wakely LJ, Jones PM. Prevention of post‐dural puncture headache in parturients:a systematic review and meta‐analysis. Acta Anaesth Scand. 2013;57:417–30.

Hafer J, Rupp D, Wollbruck M, Engel J, Hempelmann G. The effect of needle type and immobilization on postspinal headache. Anaesthesist. 1997;46:860-66.

Lambert DH, Hurley RJ, Hertwig L, Data S. Role of needle gauge and tip configuration in the production of lumbar puncture headache. Reg Anesth. 1997;22:66-72.

Santanen U, Rautoma P, Luurila H, et al. Comparison of 27-gauge Whitacre and Quincke spinal needles with respect to post-dural puncture headache and nondural puncture headache. Acta Anaesthesiol Scand. 2004;48:474–79.

Jeanjean P, Montpellier D, Carnec J, Crasquin O, Koral E, Line B, et al. Headaches after spinal anesthesia:prospective multicenter study of a young adult population. France Ann Fr Anesth Reanim. 1997;16:350-53.

Pjević M, Gvozdenović L. Postspinal headache--incidence and prognosis. Med Pregl. 1993;46:201-4.

Boonmak P, Boonmak S. Epidural blood patching for preventing and treating post-dural puncture headache. Cochrane Database Syst Rev. 2010:20;CD001791.

Lin W, Geiderman J. Medical myth:Fluids, bed rest, and caffeine are effective in preventing and treating patients with post‐lumbar puncture headache. West J Med. 2002;176:69‐70.

Arevalo-Rodriguez I, Ciapponi A, Roqué I, Figuls M, Muñoz L, Bonfill Cosp X. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev. 2016;7:CD009199.

Frolich MA, Caton D. Pioneers in epidural needle design. Anesth Analg. 2001;93:215‐20.

Bradbury CL, Singh SI, Badder SR, Wakely LJ, Jones PM. Prevention of post-dural puncture headache in parturients:a systematic review and meta-analysis. Acta Anaesthesiol Scand. 2013;57:417-30.

Oh J, Camann W. Severe, acute meningeal irritative reaction after epidural blood patch. Anesth Analg. 1998;87:1139–40.

Griffiths AG, Beards SC, Jackson A, Horsman EL. Visualization of extradural blood patch for post lumbar puncture headache by magnetic resonance imaging. Br J Anaesth. 1993;70:223-25.

Usubiaga JE, Usubiaga LE, Brea LM, Goyena R. Effect of saline injections on epidural and subarachnoid space pressures and relation to postspinal anesthesia headache. Anesth Analg. 1967;46:293-96.

Higuchi H, Adachi Y, Kazama T. Effects of epidural saline injection on cerebrospinal fluid volume and velocity waveform:a magnetic resonance imaging study. Anesthesiology. 2005;102:285–92.

Richardson MG, Wissler RN. Density of lumbar cerebrospinal fluid in pregnant and nonpregnant humans. Anesthesiology. 1996;85:326-30.

Lindvall-Axelsson M, Owman C. Actions of sex steroids and corticosteroids on rabbit choroid plexus as shown by changes in transport capacity and rate of cerebrospinal fluid formation. Neurol Res. 1990;12:181-86.

Gill JB, Heavner JE. Visual impairment following epidural fluid injections and epiduroscopy: a review. Pain Med. 2005;6:367–74.

Harrington BE, Schmitt AM. Meningeal (postdural) puncture headache, unintentional dural puncture, and the epidural blood patch: a national survey of United States practice. Reg Anesth Pain Med. 2009;34:430-37.

Peter JD, Edward TC. The epidural blood patch. Resolving the controversies. Can J Anesth. 1999;9:878-86.






Research Article

How to Cite

Uludag Öznur, Tutak A. Efficacy of prophylactic epidural saline for reducing postdural puncture headache in patients undergoing caesarean section. J Surg Med [Internet]. 2019 Aug. 1 [cited 2022 Jun. 30];3(8):593-7. Available from: https://jsurgmed.com/article/view/604790