Study the Effect of Spinal Anesthesia upon Demographic Parameters At Al-Ramadi Teaching Hospital in Anbar Governorate

Document Type : Original Article


1 Higher Institution of Health in Anbar, Anbar Health Directorate, Ministry of Health, Iraq

2 General Directorate of Anbar Education, Ministry of Education, Iraq

3 College of Medicine, University of Fallujah, Anbar, Iraq


Post-Dural puncture headache (PDPH) is an unpleasant consequence following regional anesthesia, especially in younger people, that requires precaution to avoid.  The purpose of this study was to examine the association between patients and demographic parameters such as age, sex, marital status, residency, and kind of operation, as well as the influence of the gage of a spinal needle on headache severity. In our recent study, the incidence is estimated to be around 20%. The size of the dural perforation is the most important element in the development of PDPH. Other variables, such as the geometry of the dural perforation and the direction of the spinal needle, play a smaller influence. Increasing the gauge (G) of the needle used for spinal anesthetic could be a sensible way to reduce the risk of PDPH. As a result, a compromise between the danger of PDPH and the danger of technical failure has been reached. We conclude to use spinal needl with the high gauge to reduce the P.D.P.H. but had non-significant on the demographic parameters. 


  1. Gibson S.J., Helme R.D., 2001. Age-related differences in pain perception and report. Clinics in geriatric Medicine. 17(3), 433-456.
  2. Arendt K., Demaerschalk B.M., Wingerchuk D.M., Camann W., 2009. Atraumatic lumbar puncture needles: after all these years, are we still missing the point? The Neurologist, 15(1), 17-20.
  3. Kwak K.H., 2017. Postdural puncture headache. Korean Journal of Anesthesiology. 70(2), 136-143.
  4. Brown D.L., Fink B.R., 1998. The history of neural blockade and pain management. Neural Blockade in Clinical Anesthesia and Management of pain, 3(1), 3-34.
  5. Dripps R.D., Vandam L.D., 1954. Long-term follow-up of patients who received 10,098 spinal anesthetics: failure to discover major neurological sequelae. Journal of the American Medical Association. 156(16), 1486-1491.
  6. Cook T.M., Counsell D., Wildsmith J.A.W., 2009. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. British Journal of Anaesthesia. 102(2), 179-190.
  7. Greene B.A., 1950. A 26 gauge lumbar puncture needle: Its value in the prophylaxis of headache following spinal analgesia for vaginal delivery. In The Journal of the American Society of Anesthesiologists.  11(4), 464-469.

8.Calthorpe N., 2004. The history of spinal needles: getting to the point. Anaesthesia. 59(12), 1231-1241.

  1. Erdem V.M., Donmez T., Uzman S., Ferahman S., Hatipoglu E., Sunamak O., 2018. Spinal/epidural block as an alternative to general anesthesia for laparoscopic appendectomy: a prospective randomized clinical study. Videosurgery and Other Miniinvasive Techniques. 13(2), 148-156.
  2. Eroglu A., Apan A., Erturk E., Ben-Shlomo I., 2015. Comparison of the anesthetic techniques. e Scientific World Journal. 2015(650684), 1-2.
  3. Chen H.T., Tsai C.H., Chao S.C., Kao T.H., Chen Y.J., Hsu H.C., Shen C.C., Tsou, H.K., 2011. Endoscopic discectomy of L5-S1 disc herniation via an interlaminar approach: Prospective controlled study under local and general anesthesia. Surgical Neurology International. 2(93), 1-7.
  4. Broadbent C.R., Maxwell W.B., Ferrie R., Wilson D.J., Gawne‐Cain M., Russell R., 2000. Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia. 55(11), 1122-1126.
  5. Ghaffari S., Dehghanpisheh L., Tavakkoli F., Mahmoudi H., 2018. The effect of spinal versus general anesthesia on quality of life in women undergoing cesarean delivery on maternal request. Cureus. 10(12), e3715.
  6. McDonald S.B., 2004. Is neuraxial blockade contraindicated in the patient with aortic stenosis? Regional Anesthesia and Pain Medicine. 29(5), 496-502.
  7. De Rojas J.O., Syre P., Welch W.C., 2014. Regional anesthesia versus general anesthesia for surgery on the lumbar spine: a review of the modern literature. Clinical Neurology and Neurosurgery. 119, 39-43.
  8. Attari M.A., Mirhosseini S.A., Honarmand A., Safavi M.R., 2011. Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: A randomized clinical trial. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences. 16(4), 524-529.
  9. Hirachan N., 2017. Incidence of post dural puncture headache in parturients following early ambulation and recumbency. Journal of Patan Academy of Health Sciences. 4(2), 14-20.
  10. Nath S., Koziarz A., Badhiwala J.H., Alhazzani W., Jaeschke R., Sharma S., Banfield L., Shoamanesh A., Singh S., Nassiri F., Oczkowski W., Belley-Côté E., Truant R., Reddy K., Meade M.O., Farrokhyar F., Bala M.M., Alshamsi F., Krag M., Etxeandia-Ikobaltzeta I., Kunz R., Nishida O., Matouk C., Selim M., Rhodes A., Hawryluk G., Almenawer S.A., 2018. Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis. The Lancet. 391(10126), 1197-1204.
  11. Veličković I., Pujic B., Baysinger C. W., Baysinger C.L., 2017. Continuous spinal anesthesia for obstetric anesthesia and analgesia. Frontiers in Medicine. 4, 133.
  12. Meng T., Zhong Z., Meng L., 2017. Impact of spinal anaesthesia vs. general anaesthesia on peri‐operative outcome in lumbar spine surgery: a systematic review and meta‐analysis of randomised, controlled trials. Anaesthesia. 72(3), 391-401.
  13. Bezov D., Lipton R.B., Ashina S., 2010. Post‐dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache: The Journal of Head and Face Pain. 50(7), 1144-1152.
  14. Gisore E., Mung’ayi V., Sharif T., 2010. Incidence of post dural puncture headache following caesarean section under spinal anaesthesia at the Aga Khan University Hospital, Nairobi. East African Medical Journal. 87(6), 227-230.
  15. Schmittner M.D., Terboven T., Dluzak M., Janke A., Limmer M.E., Weiss C., Bussen D.G., Burmeister M.A., Beck G.C., 2010. High incidence of post-dural puncture headache in patients with spinal saddle block induced with Quincke needles for anorectal surgery: a randomised clinical trial. International Journal of Colorectal Disease. 25(6), 775-781.
  16. Buvanendran A., Kroin J.S., Della Valle C.J., Kari M., Moric M., Tuman K. J., 2010. Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesthesia & Analgesia. 110(1), 199-207.
  17. Akdemir M.S., Kaydu A., Yanlı Y., Özdemir M., Gökçek E., Karaman H., 2017. The postdural puncture headache and back pain: The comparison of 26-gauge atraucan and 26-gauge quincke spinal needles in obstetric patients. Anesthesia, Essays and Researches. 11(2), 458-462.
  18. Uchino K., 2018. Atraumatic lumbar puncture needles reduce postdural puncture headache compared with conventional needles. Annals of Internal Medicine. 168(6), JC34.
  19. Zorrilla-Vaca A., Mathur V., Wu C.L., Grant M.C., 2018. The impact of spinal needle selection on postdural puncture headache: a meta-analysis and metaregression of randomized studies. Regional Anesthesia & Pain Medicine. 43(5), 502-508.