Clinical Audit: Anaesthesia

K. Senthil Kumar

HOD Anaesthesiology, Kauvery Hospitals, Trichy

Objective

To reduce the incidence of post dural puncture headache in patients undergoing spinal anaesthesia

Background

  1. Place of Audit: KMC Specialty Hospital, Trichy Cantonment.
  2. Date of Audit: 01/05/2022 to 31/12/2022
  3. Source of Audit: Operation theatre, KMC Specialty Hospital, Cantonment.
  4. Team: Department of Anaesthesiology

Purpose and summary of clinical audit

  1. Postdural puncture headache (PDPH) is a major complication of neuraxial anaesthesia and with inadvertent dural puncture during epidural anaesthesia.
  2. PDPH can be incapacitating, causing significant morbidity. It may extend the length of the hospital stay or evolve into chronic headache.
  3. One of the reason for PDPH is using Bevel cut (Quincke) needle for spinal anaesthesia.
  4. The aim of this audit is to reduce the incidence of post-dural puncture headache by using pencil point (Whitacre) needles.

DATA of the year 2022 May to August

  1. With the use of (Quincke) cutting needle.
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Methodology

  1. Subarachnoid block ( SAB) was given using 26 G Quincke needle for all patients undergoing infra-umbilical surgeries.
  2. All the patients were monitored postoperatively for symptoms of post-dural puncture headache like bilateral frontal or occipital headache, nausea, photophobia, nuchal pain over the period of four months.
  3. Symptomatic patients were monitored for the duration of Length of stay(LOS).
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Symptoms

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Observation

  1. 21% of the population had headache restricting their day to day activities.
  2. 14.4% of the population had nausea
  3. 14.6% of the population had nuchal pain
  4. 9.8% of the population had photophobia and
  5. 17.8% of the population had increased length of hospital stay.

All symptomatic patients were treated with:

  1. T. Paracetamol 650mg thrice a day, Inj. Ondansetron 4 mg I.V BD, I.V. Fluids, strict bed rest.
  2. Some patients were treated with caffeine if headache was severe.

When patients were dissatisfied due to adverse effects following SAB, methods to improve patient outcome were analysed.

Corrections implemented

  1. We collected information from various articles and journals; it had been found that using pencil point needles have reduced the incidence of post dural puncture headache.
  2. Our aim was :
  1. To reduce the incidence of post-dural puncture headache following spinal anaesthesia.
  2. To reduce the length of hospital stay by decreasing the incidence of headache, nausea, nuchal pain, photophobia.
  3. Avoid a later intervention by epidural blood patch.

Data collected in the year 2022 September to December

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  1. After introduction of Whitacre needle

Observations

  1. 2% of the population had headache
  2. 1.2% of the population had nausea.
  3. 1% of the population had nuchal pain
  4. None of the patient had photophobia
  5. 0.2% Of the population had increased length of hospital stay due to complications related to PDPH.

Quincke cases

Percentage

Whitacre cases

Percentage

Total cases

 1345 1434

Headache

 282 21% 28 2%

Vomiting

 193 14% 17 1.2%

Photophobia

 131 9.8% 0 0%

Nuchal pain

 196 14.6% 14 1%

Length of hospital stay

 239 18% 2 0.2%

Conclusion

  1. Thus, post dural puncture headache was reduced effectively with the change in type of needle used for subarachnoid block.
Senthil

Dr. K. Senthil Kumar

Head of the Department – Anaesthesiology and Toxicology

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