Comparative Analysis of Demographic and Procedural Risk Factors for Post-Dural Puncture Headache Following Spinal Versus Epidural Anesthesia

Abstract

Background: Post-dural puncture headache (PDPH) is a significant complication of neuraxial anesthesia, with unclear comparative risk profiles between spinal and epidural techniques despite advancements in procedural standards. Addressing this gap, our study investigates demographic and procedural factors associated with PDPH to inform safer anesthetic practice. Objective: To compare the distribution of patient age, number of puncture attempts, and bevel orientation in individuals developing PDPH after spinal versus epidural anesthesia, evaluating for statistically and clinically meaningful differences. Methods: This was a multi-center observational study including 70 patients (n = 70) who developed PDPH after spinal or epidural anesthesia for elective surgery. Adults aged 18–65 years, ASA I–II, BMI 18.5–30 kg/m² were included; patients with prior neurological disorders, migraines, coagulopathies, pregnancy, or spinal abnormalities were excluded. Data were prospectively collected on demographics and procedural details using standardized forms. Outcome measures were PDPH incidence related to anesthesia type, age group, number of puncture attempts, and bevel orientation. The study received ethical approval from The Superior University, Lahore, and adhered to the Helsinki Declaration. Statistical analyses included chi-square tests for categorical variables using SPSS version 27.0. Results: No statistically significant differences were observed between spinal and epidural anesthesia groups in age distribution (p = 0.997), number of puncture attempts (p = 0.779), or bevel orientation (p = 0.540). The majority of PDPH cases were observed in the 28–38-year age group and among patients with perpendicular bevel orientation, but group differences were not significant. Conclusion: Patient age, number of puncture attempts, and bevel orientation did not differ significantly between spinal and epidural anesthesia recipients with PDPH. These findings suggest that, with proper procedural standards, the risk of PDPH may be comparable between techniques, emphasizing the importance of individualized risk assessment and procedural quality in clinical anesthesia practice.