Effect of night work on the incidence of post-dural puncture headache in caesarian section patients at King Abdullah University Hospital

Abstract

Background: Post-dural puncture headache (PDPH)is aknown incapacitating complication after dural puncture. There are many risk factors for the development of this complication. Night work time is associated with sleep interruption and exhaustion with consequent work incidents. The effect of night time work on development of PDPHis speculative and non-conclusive so far. The aim of this study was to test this work time effect in obstetric ward. Methods: In this prospective observational study in a university hospital, we compared the incidence of PDPH between parturients undergoing spinal anesthesia for caesarean section based on work time. Using standard diagnostic criteria, patients were followed up to five days postoperatively using clinical visits and phone calls. Working time was further tested as a risk factor for the development of PDPH using appropriate statistical techniques. Results: Patients were comparable between the two work time groups in their demographic, obstetric, and procedure profiles (P>0.05). The overall incidence of PDPH was 26% (44/167). Night work group had a significantly higher incidence of PDPH compared to day time group: 40% (17/42) vs 21.6%(27/125), respectively, P<0.05. Regression analysis showed that work time was also significantly correlated as a risk factor with PDPH (OR=2.58, CI 1.07-6.23, P<0.05). Conclusions: our study has shown that caesarean section under spinal anesthesia at night time is associated with higher incidence of PDPH than those at day time. Specially designed studies are encouraged to search for the underlying cause of this difference.