Incidence of Post Dural Puncture Headache (PDPH) Following Subarachnoid Block in Lower Segment Caesarean Section: A Hospital-based Prospective Observational Study

Background: Post-dural puncture headache (PDPH) remains one of the most distressing complications of spinal anaesthesia, particularly relevant in obstetric anaesthesia where subarachnoid block is commonly employed for caesarean sections. This study aimed to determine the incidence of PDPH following subarachnoid block in patients undergoing lower segment caesarean section (LSCS) and identify associated risk factors in a tertiary care hospital in Eastern India. Methodology: This prospective observational study was conducted over 18 months (January 2019 to June 2020) at Tata Main Hospital, Jamshedpur. A total of 1305 patients undergoing LSCS under subarachnoid block were enrolled. Patient demographics, obstetric history, and anaesthetic technique-related variables—including needle size, number of attempts, and operator experience—were recorded. Patients were followed postoperatively for five days for the onset of headache and assessed clinically for PDPH. Results: The overall incidence of PDPH was 1.5% (19/1305 patients). Among patients reporting headache, 56% experienced onset within 24-48 hours, with predominantly mild intensity and postural characteristics. The headache duration averaged 27.2±11.6 hours. The number of dural puncture attempts was significantly associated with PDPH occurrence (p=0.030), with incidence rising from 1.2% in a single attempt to 8.3% in ≥2 attempts. No significant associations were found with age, needle gauge, gravida status, operator experience, or bupivacaine dose. Conclusion: This study demonstrated a low PDPH incidence following spinal anaesthesia for caesarean section. Technical precision in achieving successful first-attempt spinal anaesthesia emerged as the most critical factor in preventing PDPH, emphasizing the importance of operator skill over traditional risk factors.