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The influence of obesity on post dural puncture headache following dural puncture with a Tuohy needle
Abstract Number: T-68
Abstract Type: Original Research
Existing studies have yielded conflicting evidence as to whether obese patients have a lower incidence of post dural puncture headache (PDPH) after dural puncture compared to non-obese patients. We therefore performed this study to assess whether the risk of PDPH varies according to body mass index (BMI).
We retrospectively reviewed our PDPH database between 1996 and 2014. This database contains prospectively collected data on parturients who experienced an inadvertent or intentional dural puncture with a Tuohy needle or developed PDPH. We searched for patients who had an obvious dural puncture as defined by witnessed CSF return through the needle or catheter during an epidural, combined spinal epidural, or continuous spinal placement using a 17 or 18 G Tuohy needle. Parturients were categorized into four groups according to BMI (kg/m2) (Non-Obese: BMI <30; Obese: BMI 30-39.9; Morbidly Obese: BMI 40-49.9; and Super Obese: BMI ≥50). The incidence (primary end point), severity (0-10 scale), and duration of PDPH, as well as the performance of a therapeutic epidural blood patch (EBP), were compared between these groups. Chi square, Wilcoxon rand sum, and Fisher exact tests were used for statistical analysis. Multivariate analysis was conducted to control for potential confounders.
190 patients were included in the analysis. Results are summarized in the table. The incidence of PDPH did not significantly differ between the four BMI groups (P=0.053). When controlling for spinal catheters and delivery by cesarean, cesarean delivery was a significant predictor of less PDPH (P=0.02) whereas BMI grade and spinal catheters were not significant predictors of PDPH (P=0.2 and 0.4 respectively). The severity of headache (maximum pain score) was significantly different between the groups, with the pairwise comparisons showing lower scores in those with BMI≥50 compared to other groups. There was no difference among the groups in duration of headache or performance of an EBP.
While our analysis did not show an overall statistically significant difference among the groups in the incidence of PDPH, the incidence appeared lower in those with BMI≥50. The severity of headache was also lower in this group of patients. Delivery by cesarean was protective against PDPH. This may explain the lower incidence in super obese patients who underwent more cesareans, which may be due to a lack of pushing during the second stage of labor.