The incidence and causes of headaches after spinal anesthesia in cesarean sections

The incidence and causes of headaches after spinal anesthesia in cesarean sections | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The incidence and causes of headaches after spinal anesthesia in cesarean sections Nawal Majed Alatich, Najwa Ragmani This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6430476/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Spinal anesthesia is the most commonly used anesthesia technique for cesarean section with a prevalence rate of 80% − 95%. The most common complications of spinal anesthesia are post-dural puncture headache associated with dural puncture and cerebrospinal fluid leak. Methods A cross-sectional descriptive study was conducted in Damascus Governorate during the period from 1/11/2024 to 5/1/2025. Data from 141 patients were studied through a questionnaire distributed in paper and electronic form, containing a set of questions that serve the research objective. Results Our study included 141 patients who underwent cesarean section under spinal anesthesia. Their ages ranged from 21–58 years, and the most participating age group was "20–30 years" (67.5%). Patients were classified by the American Society of Anesthesiologists (ASA): "ASA1" (95.7%), "ASA2" (4.3%). History of spinal anesthesia (48.9%). Number of attempts with a puncture needle: "once" (39.7%), "twice" (22.7%). Academic level of the person performing the spinal block: "physician" (44.7%), anesthesia technician (55.3%). Symptoms experienced by patients after spinal anesthesia: "nausea/vomiting" (48.3%), "tinnitus" (17.9%), "foveal rigidity" (15.5%), "double vision" (11.1%). Conclusion In our study, the incidence of headache after dural puncture was 3.5%. Studies show that factors such as needle size, number of attempts, body mass index, and anesthesiologist experience are associated with increased incidence of headache. Repeated attempts were observed to increase the likelihood of headache by 1.5 to 4 times. Headache rate was higher when anesthesia was administered by an anesthesia technician than by an anesthesiologist. Our study did not show an association between these factors and headache incidence, which is attributed to the difference in sample sizes studied. Anesthesiology & Pain Medicine Post-dural headache post-spinal headache Cesarean section Background According to the International Headache Society, post-dural puncture headache (PDPH) is defined as a headache occurring within 5 days of a dural puncture. It is characterized by bilateral, vague pain originating in the frontal region and radiating to the back of the head. It worsens within 15 minutes of sitting/standing, sneezing, coughing, and tension, and improves within 15 minutes of lying down. [ 1 – 9 ] This headache is accompanied by neck stiffness, dizziness, photophobia, tinnitus, and double vision, as well as nausea and vomiting. These symptoms resolve spontaneously within one week or after the leak is sealed with an autogenous epidural patch within 48 hours. However, PDPH is not associated with fever, leukocytosis, and neurological deficits. [ 1 – 9 ] PDPH is a devastating complication of procedures that puncture the dura mater, such as epidural/spinal anesthesia, accidental dural puncture during spinal surgery, diagnostic lumbar puncture, myelography, and epidural injections. [ 10 – 12 ] Although PDPH can occur immediately after a dural puncture, 90% occur within 3 days, and 66% of cases will begin within the first 48 hours of the puncture. [ 13 , 8 ] According to the International Classification of Headache Disorders criteria, 29% of patients experience headache alone without other symptoms. This finding suggests that headache is a key diagnostic criterion for diagnosing PDPH. [ 6 ] Although the exact cause of PDPH remains unknown, the primary cause of PDPH is a cerebrospinal fluid leak, which progresses over a period of minutes to several hours. This is associated with a sudden cerebrospinal fluid leak and decreased cerebrospinal fluid pressure, ultimately leading to gravitational stress on pain-sensitive structures. In addition, the onset of PDPH secondary to cerebrospinal fluid leak is a result of activation of adenosine receptors, which subsequently causes dilation of intracranial arteries and veins to compensate for the increase in blood volume through the Monro-Kelly nodule. [ 16 , 15 , 14 , 11 ] Obstetric patients are at risk for PDPH due to their gender, age, and higher exposure to nerve blocks. [ 17 , 7 , 4 ] The pain of PDPH is severe and causes discomfort for the patient, which can lead to maternal dissatisfaction with spinal anesthesia, disruption of child care, increased healthcare costs, hospital stays, and emergency department visits, as well as an increased risk of spinal anesthesia refusal later. Aim of the study Post-spinal anesthesia headache is a common complication that can significantly impact maternal health after cesarean delivery. Given that spinal anesthesia remains the preferred method for cesarean delivery due to its effectiveness and safety, understanding the incidence and causes of associated headaches is crucial. These headaches not only cause discomfort for the patient but can also impede early mother-infant bonding and prolong hospital stay. Our study aims to shed light on the incidence and causes of post-spinal headaches in cesarean deliveries, ultimately leading to improved maternal care and patient satisfaction in obstetric anesthesia. Methods A descriptive, cross-sectional study was conducted in Damascus Governorate from November 1, 2024 to January 5, 2025. Data from 141 patients were collected using a questionnaire distributed electronically and in paper form. The questionnaire contained a set of questions to serve the research purpose. Our study included patients who underwent a cesarean section under spinal anesthesia and subsequently suffered from headaches. We excluded patients with other causes of headaches, such as migraines or a history of headaches. Approval was obtained from the Syrian Private University to distribute the questionnaire. Statistical analysis: Patient data were tabulated and entered into the computer. The questionnaires prepared by the students were collected and filled out and entered into the Excel program. Then, the Statistical Package for the Social Sciences (SPSS) program, version (26), was used to analyze this data. The following statistical methods were used in the analysis: Descriptive analysis: This consists of finding the relative frequency distributions of the categorical study variables (gender, place of residence, financial status, etc.) and adding graphic forms to enrich the results. Inferential analysis: This part of the analysis aims to present and interpret the results and infer from them in order to reach the study objective, by conducting the Chi Square test of independence to study whether there is a relationship between two descriptive variables by applying the Chi Square statistic. Results Descriptive Analysis: Our study included 141 patients who underwent cesarean section under spinal anesthesia. Table 1 shows the distribution of patients by age group, as follows: 95 (67.4%) were aged 20-30 years, 42 (29.8%) were aged 31-45 years, and 46-60 years (2.8%). Their ages ranged from 21-58 years, with a mean age of 29 years and a standard deviation of 6.8. Table 2 shows the distribution of patients by body mass index, as follows: 92 (65.2%) were aged 18.5-24.9 years, 31 (22%) were aged 25-29.9 years, and 18 (12.8%) were aged 30-39.9 years. Table 3 shows the distribution of patients according to their economic status: "Good" 77 (54.6%), "Very Good" 43 (30.5%), "Excellent" 15 (10.6%), and "Weak" 6 (4.3%). Table 4 shows the patients' responses regarding their suffering from chronic diseases. Most of them answered "No" (130% of the patients (92.2%), compared to "Yes" (11% of the patients (7.8%). Table 5 shows that most of them do not suffer from migraines (135% of the patients (95.7%)), compared to 6 (4.3%) who do. Table 6 shows that those who take only neurological medications (4% of the patients (2.8%)), compared to 137 (97.2%) who do not. Table 7 shows that, according to the American Society of Anesthesiologists (ASA) classification, 135 (95.7%) of patients fell into the "ASA" category, and 6 (4.3%) fell into the "ASA" category. Table 8 shows that 69 (48.9%) of patients had previously undergone spinal anesthesia, compared to 72 (51.1%) who answered "no." Table 9 shows that 45 (31.9%) of patients had a history of headaches after spinal anesthesia, compared to 96 (68.1%) who did not experience headaches. Table 10 shows that 5 (3.5%) of patients currently had headaches after spinal anesthesia, compared to 136 (96.5%) who did not experience headaches. Table 11 shows the position of the patients undergoing spinal anesthesia: 89 (63.1%) were in the sitting position, compared to 52 (36.9%) in the supine position. Table 12 shows the number of attempts to insert the needle was as follows: 103 (70%) were in the "once" position, and 32 (22.7%) were in the "twice" position. Table 13 shows that 125 (88.7%) patients reported that the block was completely successful. Table 14 shows the academic level of those performing the spinal block: 63 (44.7%) were physicians, compared to 78 (55.3%) anesthesia technicians. Table 15 shows the symptoms experienced by patients after undergoing spinal anesthesia, which were as follows: “nausea/vomiting” in 100 (48.3%), “tinnitus” in 37 (17.9%), “foveal rigidity” in 32 (15.5%), and “double vision” in 23 (11.1%) . Inferential Analysis: The Chi-square test of independence was used to determine whether there was a relationship between two descriptive variables. The chi-square statistic was used to determine statistical significance if the p-value was <0.05. Table 16 shows a study of the headache incidence in relation to the anesthesia position. The percentage of patients who experienced headache was higher in the sitting position (2.8%) compared to the supine position, but the difference was not statistically significant (P-Value >0.05). Table 17 shows a study of the headache incidence in relation to the number of attempts. The percentage of patients who experienced headache was higher in the first attempt than in the second, but the difference was not statistically significant (P-Value >0.05). Table 18 shows a study of headache incidence in relation to the academic level of the person performing the procedure. The proportion of patients who experienced headaches was higher when the procedure was performed by an anesthesiologist than by a physician, but the difference was not statistically significant (P-value >0.05). Table 16 shows a study of headache incidence in relation to body mass index (BMI). The proportion of patients who experienced headaches was higher in the 18.5-24.9 category, followed by the 30-39.9 category, but the difference was not statistically significant (P-value >0.05). Discussion Currently, 80–95% of cesarean deliveries are performed under spinal anesthesia due to its simplicity, rapid onset, and excellent sensory and motor blocking due to maternal alertness during delivery and early breastfeeding. It also provides good postoperative analgesia, avoiding airway obstruction and the risk of aspiration [ 1 – 4 ]. Although spinal anesthesia is considered safe, it is not free of complications. The most common complication of spinal anesthesia is post-dural puncture headache, which is associated with dura mater puncture and cerebrospinal fluid leakage [ 5 – 8 ]. The primary cause of post-dural puncture headache is cerebrospinal fluid leakage, which occurs acutely within minutes to several hours. This is associated with sudden cerebrospinal fluid leakage and decreased cerebrospinal fluid pressure, ultimately leading to gravitational stress on pain-sensitive structures and displacement of intracranial structures. In addition, the occurrence of post-dural puncture headaches secondary to cerebrospinal fluid leakage is a result of activation of adenosine receptors, which subsequently causes dilation of intracranial arteries and veins as a compensatory increase in blood volume through the canal of Monro [ ]. Evidence has also revealed that the incidence of post-dural puncture headaches ranges from 0 to 42.6% after spinal anesthesia and 81% after accidental puncture [ 12 ]. The incidence of post-dural puncture headaches in our study was 3.5%, which is lower than in studies conducted in eastern Ethiopia, Kenya, Cairo, Egypt, and elsewhere due to the different sample sizes [ 9–11 ]. In these studies, needle size, number of attempts, body mass index, needle direction, and anesthesiologist experience were significantly associated with the occurrence of post-dural puncture headaches. In our studies, participants had difficulty determining the needle size used due to their lack of knowledge of the procedure. Repeated attempts increase the incidence of post-dural puncture headaches by 1.5 to 4 times compared to a single attempt. In our study, the number of attempts ranged from one to two, with one case undergoing four attempts. According to Dawit et al., mothers who underwent a single spinal anesthesia had a 62.6% lower risk of developing post-dural puncture headaches than mothers who underwent multiple spinal anesthesia attempts [ 12 ]. An Ethiopian study [ 12 ] reported that spinal anesthesia performed by an anesthesiologist with more than 3 years of experience reduced the incidence of post-dural puncture headaches by 56% compared to an anesthesiologist with less than 3 years of experience. This finding differs from other studies, which have shown that anesthesiologists' experience is not associated with post-dural puncture headaches. In our study, the incidence of headaches was higher when performed by an anesthesia technician than by an anesthesiologist. In our findings, a body mass index (BMI) greater than 30 kg/m² increased the incidence of post-dural puncture headaches by 2.85 times. In our results, a BMI greater than 30 kg/m² increased the incidence of post-dural puncture headache by 2.85 times [ 16 ]. Our study did not demonstrate an association between these factors (number of attempts, experience of the practitioner, BMI, and patient positioning during the procedure) and the incidence of post-dural puncture headache. This is primarily due to the difference in sample sizes between these studies. Conclusion In our study, the incidence of post-dural puncture headache was 3.5%. Studies show that factors such as needle size, number of attempts, body mass index, and anesthesiologist experience are associated with increased headache incidence. Repeated attempts were observed to increase the likelihood of headache by 1.5 to 4 times. Headache rates were higher when anesthesia was administered by an anesthesiologist compared to an anesthesiologist. Our study did not demonstrate an association between these factors and headache incidence, possibly due to the difference in sample sizes. Declarations Declarations Ethical statement: The ethical consent was obtained from Syrian private university ethical committee Competing Interest: the authors declare no competing of interests. Availability of data and materials: All data are available from the corresponding author on reasonable request. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. References Sunana Gupta N.M., Mahajan Arti, Reidwan Dar Mohd, Gupta Neeraj. Role of oral prednisolone in the management of postdural puncture headache after spinal anesthesia in urological patients. Anesth. Essays Res. 2017;11:1075–1078. doi: 10.4103/0259-1162.183565. [DOI] [PMC free article] [PubMed] [Google Scholar] Asoke Chakraborty A.S. The incidence of post dural puncture headache following spinal anaesthesia:- A comparison of sitting versus lateral decubitus position. International Journal of Contemporary Medical Research. 2016;3(7):2096–2099. [Google Scholar] Chao-Jie Yang T.C., Ni Xin, Wang W-YYaW. Effect of pre-administration with aminophylline on th occurrence of post-dural puncture headache in women undergoing caesarean section by combined spinal-epidural anaesthesia. J. Int. Med. Res. 2019;47(1):420–426. doi: 10.1177/0300060518803231. [DOI] [PMC free article] [PubMed] [Google Scholar] Carrazana G.M.F.B.Y., Sánchez Y.O., Pardo S.G., Zamora B.B., et al. Factors that influence the appearance of post-puncture dural headache in patients undergoing elective cesarean section. Int. J. Anesthesiol. Pain Med. 2018;5 1:1. [Google Scholar] Naghibi K.H.M. Prophylactic administration of aminophylline plus dexamethasone reduces post-dural puncture headache better than using either drug alone in patients undergoing lower extremity surgery. Adv. Biomed. Res. 2014;3(5) doi: 10.4103/2277-9175.124631. [DOI] [PMC free article] [PubMed] [Google Scholar] Ogunbanjo O.B.O.G.A. Postdural puncture headache: evidence-based review for primary care. Afr. Family Pract. 2015;57(4):241–246. [Google Scholar] Kassa Adugna Aregawi, Ba T.K., D Z.A. Post dural puncture headache (PDPH) and associated factors after spinal anesthesia among patients in university of gondar referral and teaching hospital, gondar, North west Ethiopia. J. Anesth. Clin. Res. 2015;6(6) [Google Scholar] Dina Y. Kassim a IME. Comparative study between hydrocortisone and mannitol in treatment of postdural puncture headache: a randomized double-blind study. Egypt. J. Anaesth. 2016;32:357–363. [Google Scholar] Sharon L., Kracoff V.K. Post dural puncture headache—review and suggested new treatment. Open J. Anesthesiol. 2016;6:148–163. [Google Scholar] Mohammed A.D.A.R., Salisu, Nagoma A.U., Owolabi L.F., Ibrahim A. An analysis of postdural puncture headache in obstetric patients: a study from Kano, Nigeria. Trop. J. Obstet. Gynaecol. 2017;34:16–20. [Google Scholar] Wang F. Intech; 2015. Post Dural Puncture Headache – We Can Prevent it. [Google Scholar] Apfel C.C., AS, Cakmakkaya O.S., George R. Gaiser E., Radke O. Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review. Br. J. Anaesth. 2010;105(3):255–263. doi: 10.1093/bja/aeq191. [DOI] [PubMed] [Google Scholar] Uma Munnur M., Suresh Maya S., Backache M.D. vol. 21. Anesthesiology Clinics of North America; 2003. pp. 71–86. (Headache, and Neurologic Deficit after Regional Anesthesia). [DOI] [PubMed] [Google Scholar] Laleh Dehghanpisheh S.B., Azemati Simin, Rakhshan Mahnaz. The effect of intravenous administration of ondansetron compared to aminophylline on incidence and severity of post-dural puncture headache (PDPH) in cesarean section surgeries. Biomed. Res. 2019;30 [Google Scholar] Sharon L., Kracoff V.K. Post dural puncture headache—review and suggested new treatment. Open J. Anesthesiol. 2016;6:148–163. [Google Scholar] Heather Suescun D., CRNA, Paul Austin P., CRNA, Dion Gabaldon D., CRNA Nonpharmacologic neuraxial interventions for prophylaxis of postdural puncture headache in the obstetric patient. AANA J. February 2016;84(1) [PubMed] [Google Scholar] Kwak K.-H. Postdural puncture headache. Kor. J. Anesthesiol. 2017;70(2) doi: 10.4097/kjae.2017.70.2.136. [DOI] [PMC free article] [PubMed] [Google Scholar] H.O. Ahmed, M. Hossam, A. Adel, Volume preload versus ephedrine infusion for prevention of hypotension due to spinal anesthesia for cesarean section, Open J. Anesthesiol. 6 (2016) 37–44. M.G. Montasser, Post dural puncture headache after spinal anesthesia for caesarean section: a comparison of 27G quincke and whitacre spinal needles in midline and paramedian approaches, J. Med. Sci. 15 (1) (2015) 44–49. M.G. Mahzad Yousefian, Comparison review of the effects of dexamethasone and ondansetron intravenous on preventing headache after spinal sedation of patients under a caesarean section in the alavi hospital, Int. J. Sci. Study 5 (3) (June 2017). lA. Shumaila Ashfaq, Muhammad Asharfzia, Rizwan Ahmad Khan, Mehatash Butt, Effect of hydrocortisone on reducing postdural puncture headache after spinal anesthsia for elective cesearean section, Ann. King Edward Med. Univ. 23 (4) (2017) 468–472. E.F. Domingos Dias Cicarelli, Fabio ´ Ely Martins Bensenor, Incidence of neurological complications and post-dural puncture headache after regional anesthesia in obstetric practice: a retrospective study of 2399 patients, Colomb. J. Anesthesiol. 42 (1) (2014) 28–32. M.T. Mortazavi, Hydrocortisone post dural puncture headache, Arch. Anesthesiol. Crit. Care 4 (1) (2018) 426–429. I.O. Ismail Sırıt, Dilek Yazıcıoglu, Aminophylline does not prevent postdural puncture headache in caesarean section, Int. J. Anesth. Anesthesiol. 3 (3) (2015). S.A. Noyan Ashraf Ma, Z. Azarbakht, E. Ssah, Hydrocortisone IN post-dural puncture headache, Middle East J. Anesthesiol. 19 (2) (2007). Ashraf Ragab, Khalid Noman Facharzt, Caffeine, Is it effective for prevention of postdural pun A.M. Dawit Tafesse, Magnitude of post dural puncture headache and associated factors in obstetric mothers undergone spinal anesthesia for caesarean section, J. Anesth. Crit. Care 11 (2) (2019). Hassan Mohamed Ali, M.Y.M.Y.M. Ahmed, Postdural puncture headache after spinal anesthesia in cesarean section: experience in six months in 2736 patients in Kasr El aini teaching hospital – Cairo University, Egypt. J. Anaesth. 30 (2014) 383–386. https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2022/06000/incidence_and_associated_factors_of_post_dural.31.aspx#:~ :text=5.-,Conclusion,with%20BMI%3E30%20kg%2Fm Tables Table1 N % Age groups 20-30 95 67.4 31-45 42 29.8 46-60 4 2.8 Total 141 100 Minimum Maximum Mean Std. Deviation 21 58 29.37 6.812 Table2 N % BMI 18.5-24.9 92 65.2 25-29.9 31 22 30-39.9 18 12.8 Total 141 100 Table3 N % Economic status Excellent 15 10.6 Very good 43 30.5 Good 77 54.6 Poor 6 4.3 Total 141 100 Table4 N % Do you suffer from chronic diseases? Yes 11 7.8 No 130 92.2 Total 141 100 Table5 N % Do you suffer from migraines? Yes 6 4.3 No 135 95.7 Total 141 100 Table 6 N % Are you taking any neurological medications? Yes 4 2.8 No 137 97.2 Total 141 100 Table 7 N % The classification that suits your health condition ASA1 135 95.7 ASA2 6 4.3 Total 141 100 Table 8 N % Have you ever had spinal anesthesia? Yes 69 48.9 No 72 51.1 Total 141 100 Table 9 N % Have you ever experienced a headache after spinal anesthesia? Yes 45 31.9 No 96 68.1 Total 141 100 Table 10 N % Are you experiencing headaches after spinal anesthesia? Yes 5 3.5 No 136 96.5 Total 141 100 Table 11 N % Position under anesthesia? Sitting 89 63.1 Lying 52 36.9 Total 141 100 Table 12 N % Number of attempts? Once 103 73 Twice 32 22.7 Three times 4 2.8 Four times 2 1.4 Total 141 100 Table 13 N % Successful blockade? Yes 125 88.7 No 16 11.3 Total 141 100 Table 14 N % Academic level of the person performing the procedure? Doctor 63 44.7 Anesthesia Technician 78 55.3 Total 141 100 Table 15 N % Associated symptoms neck stiffness 32 15.5% Tinnitus 37 17.9% Double vision 23 11.1% Photophobia 15 7.2% Nausea and/or vomiting 100 48.3% Total 207 100.00% Table 16 Are you experiencing headaches after spinal anesthesia? Total Yes No Position under anesthesia? Sitting Count 4 85 89 % of Total 2.80% 60.30% 63.10% lying Count 1 51 52 % of Total 0.70% 36.20% 36.90% Total Count 5 136 141 % of Total 3.50% 96.50% 100.00% P-Value=0.4 Table 17 Are you experiencing headaches after spinal anesthesia? Total Yes No Number of attempts? Once Count 3 100 103 % of Total 2.10% 70.90% 73.00% Twice Count 2 30 32 % of Total 1.40% 21.30% 22.70% Three times Count 0 4 4 % of Total 0.00% 2.80% 2.80% Four times Count 0 2 2 % of Total 0.00% 1.40% 1.40% Total Count 5 136 141 % of Total 3.50% 96.50% 100.00% P-Value=0.7 Table 18 Are you experiencing headaches after spinal anesthesia? Total Yes No What is the academic level of the person performing the procedure? Doctor Count 2 61 63 % of Total 1.40% 43.30% 44.70% Anesthesia Technician Count 3 75 78 % of Total 2.10% 53.20% 55.30% Total Count 5 136 141 % of Total 3.50% 96.50% 100.00% P-Value=0.8 Are you experiencing headaches after spinal anesthesia? Total Yes No Body mass index 18.5-24.9 Count 4 88 92 % of Total 2.80% 62.40% 65.20% 25-29.9 Count 0 31 31 % of Total 0.00% 22.00% 22.00% 30-39.9 Count 1 17 18 % of Total 0.70% 12.10% 12.80% Total Count 5 136 141 % of Total 3.50% 96.50% 100.00% P-Value=0.2 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6430476","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":441828882,"identity":"971889f4-ea94-4772-a953-46785f8e4cd7","order_by":0,"name":"Nawal Majed Alatich","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYBADZgaG5ANA2oKBgYd4LWkJDAwJEsRrAYIcA+K0mLP3HnzAmGPHzs+e8/Ex7w8JOX6eA4wfPubg1mLZcy7ZgHFbMrNkz9vNxjwJEsaSvQ3MkjO34dZicCPHTIJxGzOzwY3cbdJALYkbzjOwMfPi03L/DUhLPbP9jZxnRGq5wQPScpjZQCKHDaLlbAMBLWdyjIF+Oc4sceaZseGcNKBfeg424/fL8TOGDxi3VSfztyc/fPDGxgYYYskHP3zEowUEmP8Aox6Jz9iAXz0U2BGlahSMglEwCkYmAADECEf01EYqZQAAAABJRU5ErkJggg==","orcid":"","institution":"Syrian Private University","correspondingAuthor":true,"prefix":"","firstName":"Nawal","middleName":"Majed","lastName":"Alatich","suffix":""},{"id":441829145,"identity":"05bd07cc-898e-4734-82ed-19c03e4be560","order_by":1,"name":"Najwa Ragmani","email":"","orcid":"","institution":"Syrian Private University","correspondingAuthor":false,"prefix":"","firstName":"Najwa","middleName":"","lastName":"Ragmani","suffix":""}],"badges":[],"createdAt":"2025-04-11 18:13:49","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6430476/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6430476/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80692735,"identity":"2df55b48-bc17-405b-a2bc-67199aa840d0","added_by":"auto","created_at":"2025-04-16 06:02:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1044943,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6430476/v1/2c3e6938-f7ee-47b0-8914-e6bc2f1db8ec.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eThe incidence and causes of headaches after spinal anesthesia in cesarean sections\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eAccording to the International Headache Society, post-dural puncture headache (PDPH) is defined as a headache occurring within 5 days of a dural puncture. It is characterized by bilateral, vague pain originating in the frontal region and radiating to the back of the head. It worsens within 15 minutes of sitting/standing, sneezing, coughing, and tension, and improves within 15 minutes of lying down. [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] This headache is accompanied by neck stiffness, dizziness, photophobia, tinnitus, and double vision, as well as nausea and vomiting. These symptoms resolve spontaneously within one week or after the leak is sealed with an autogenous epidural patch within 48 hours. However, PDPH is not associated with fever, leukocytosis, and neurological deficits. [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003ePDPH is a devastating complication of procedures that puncture the dura mater, such as epidural/spinal anesthesia, accidental dural puncture during spinal surgery, diagnostic lumbar puncture, myelography, and epidural injections. [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAlthough PDPH can occur immediately after a dural puncture, 90% occur within 3 days, and 66% of cases will begin within the first 48 hours of the puncture. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAccording to the International Classification of Headache Disorders criteria, 29% of patients experience headache alone without other symptoms. This finding suggests that headache is a key diagnostic criterion for diagnosing PDPH. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAlthough the exact cause of PDPH remains unknown, the primary cause of PDPH is a cerebrospinal fluid leak, which progresses over a period of minutes to several hours. This is associated with a sudden cerebrospinal fluid leak and decreased cerebrospinal fluid pressure, ultimately leading to gravitational stress on pain-sensitive structures.\u003c/p\u003e \u003cp\u003eIn addition, the onset of PDPH secondary to cerebrospinal fluid leak is a result of activation of adenosine receptors, which subsequently causes dilation of intracranial arteries and veins to compensate for the increase in blood volume through the Monro-Kelly nodule. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eObstetric patients are at risk for PDPH due to their gender, age, and higher exposure to nerve blocks. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe pain of PDPH is severe and causes discomfort for the patient, which can lead to maternal dissatisfaction with spinal anesthesia, disruption of child care, increased healthcare costs, hospital stays, and emergency department visits, as well as an increased risk of spinal anesthesia refusal later.\u003c/p\u003e"},{"header":"Aim of the study","content":"\u003cp\u003ePost-spinal anesthesia headache is a common complication that can significantly impact maternal health after cesarean delivery. Given that spinal anesthesia remains the preferred method for cesarean delivery due to its effectiveness and safety, understanding the incidence and causes of associated headaches is crucial. These headaches not only cause discomfort for the patient but can also impede early mother-infant bonding and prolong hospital stay. Our study aims to shed light on the incidence and causes of post-spinal headaches in cesarean deliveries, ultimately leading to improved maternal care and patient satisfaction in obstetric anesthesia.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eA descriptive, cross-sectional study was conducted in Damascus Governorate from November 1, 2024 to January 5, 2025. Data from 141 patients were collected using a questionnaire distributed electronically and in paper form. The questionnaire contained a set of questions to serve the research purpose. Our study included patients who underwent a cesarean section under spinal anesthesia and subsequently suffered from headaches. We excluded patients with other causes of headaches, such as migraines or a history of headaches. Approval was obtained from the Syrian Private University to distribute the questionnaire.\u003c/p\u003e\u003ch2\u003eStatistical analysis:\u003c/h2\u003e\u003cp\u003ePatient data were tabulated and entered into the computer. The questionnaires prepared by the students were collected and filled out and entered into the Excel program. Then, the Statistical Package for the Social Sciences (SPSS) program, version (26), was used to analyze this data. The following statistical methods were used in the analysis: Descriptive analysis: This consists of finding the relative frequency distributions of the categorical study variables (gender, place of residence, financial status, etc.) and adding graphic forms to enrich the results. Inferential analysis: This part of the analysis aims to present and interpret the results and infer from them in order to reach the study objective, by conducting the Chi Square test of independence to study whether there is a relationship between two descriptive variables by applying the Chi Square statistic.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDescriptive Analysis:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Our study included 141 patients who underwent cesarean section under spinal anesthesia. Table 1 shows the distribution of patients by age group, as follows: 95 (67.4%) were aged 20-30 years, 42 (29.8%) were aged 31-45 years, and 46-60 years (2.8%). Their ages ranged from 21-58 years, with a mean age of 29 years and a standard deviation of 6.8. Table 2 shows the distribution of patients by body mass index, as follows: 92 (65.2%) were aged 18.5-24.9 years, 31 (22%) were aged 25-29.9 years, and 18 (12.8%) were aged 30-39.9 years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 3 shows the distribution of patients according to their economic status: \u0026quot;Good\u0026quot; 77 (54.6%), \u0026quot;Very Good\u0026quot; 43 (30.5%), \u0026quot;Excellent\u0026quot; 15 (10.6%), and \u0026quot;Weak\u0026quot; 6 (4.3%). Table 4 shows the patients\u0026apos; responses regarding their suffering from chronic diseases. Most of them answered \u0026quot;No\u0026quot; (130% of the patients (92.2%), compared to \u0026quot;Yes\u0026quot; (11% of the patients (7.8%). Table 5 shows that most of them do not suffer from migraines (135% of the patients (95.7%)), compared to 6 (4.3%) who do. Table 6 shows that those who take only neurological medications (4% of the patients (2.8%)), compared to 137 (97.2%) who do not.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Table 7 shows that, according to the American Society of Anesthesiologists (ASA) classification, 135 (95.7%) of patients fell into the \u0026quot;ASA\u0026quot; category, and 6 (4.3%) fell into the \u0026quot;ASA\u0026quot; category. Table 8 shows that 69 (48.9%) of patients had previously undergone spinal anesthesia, compared to 72 (51.1%) who answered \u0026quot;no.\u0026quot;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 9 shows that 45 (31.9%) of patients had a history of headaches after spinal anesthesia, compared to 96 (68.1%) who did not experience headaches. Table 10 shows that 5 (3.5%) of patients currently had headaches after spinal anesthesia, compared to 136 (96.5%) who did not experience headaches.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 11 shows the position of the patients undergoing spinal anesthesia: 89 (63.1%) were in the sitting position, compared to 52 (36.9%) in the supine position. Table 12 shows the number of attempts to insert the needle was as follows: 103 (70%) were in the \u0026quot;once\u0026quot; position, and 32 (22.7%) were in the \u0026quot;twice\u0026quot; position. Table 13 shows that 125 (88.7%) patients reported that the block was completely successful.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 14 shows the academic level of those performing the spinal block: 63 (44.7%) were physicians, compared to 78 (55.3%) anesthesia technicians. Table 15 shows the symptoms experienced by patients after undergoing spinal anesthesia, which were as follows: \u0026ldquo;nausea/vomiting\u0026rdquo; in 100 (48.3%), \u0026ldquo;tinnitus\u0026rdquo; in 37 (17.9%), \u0026ldquo;foveal rigidity\u0026rdquo; in 32 (15.5%), and \u0026ldquo;double vision\u0026rdquo; in 23 (11.1%)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInferential Analysis:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The Chi-square test of independence was used to determine whether there was a relationship between two descriptive variables. The chi-square statistic was used to determine statistical significance if the p-value was \u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 16 shows a study of the headache incidence in relation to the anesthesia position. The percentage of patients who experienced headache was higher in the sitting position (2.8%) compared to the supine position, but the difference was not statistically significant (P-Value \u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 17 shows a study of the headache incidence in relation to the number of attempts. The percentage of patients who experienced headache was higher in the first attempt than in the second, but the difference was not statistically significant (P-Value \u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 18 shows a study of headache incidence in relation to the academic level of the person performing the procedure. The proportion of patients who experienced headaches was higher when the procedure was performed by an anesthesiologist than by a physician, but the difference was not statistically significant (P-value \u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 16 shows a study of headache incidence in relation to body mass index (BMI). The proportion of patients who experienced headaches was higher in the 18.5-24.9 category, followed by the 30-39.9 category, but the difference was not statistically significant (P-value \u0026gt;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCurrently, 80\u0026ndash;95% of cesarean deliveries are performed under spinal anesthesia due to its simplicity, rapid onset, and excellent sensory and motor blocking due to maternal alertness during delivery and early breastfeeding. It also provides good postoperative analgesia, avoiding airway obstruction and the risk of aspiration [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough spinal anesthesia is considered safe, it is not free of complications. The most common complication of spinal anesthesia is post-dural puncture headache, which is associated with dura mater puncture and cerebrospinal fluid leakage [\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe primary cause of post-dural puncture headache is cerebrospinal fluid leakage, which occurs acutely within minutes to several hours. This is associated with sudden cerebrospinal fluid leakage and decreased cerebrospinal fluid pressure, ultimately leading to gravitational stress on pain-sensitive structures and displacement of intracranial structures. In addition, the occurrence of post-dural puncture headaches secondary to cerebrospinal fluid leakage is a result of activation of adenosine receptors, which subsequently causes dilation of intracranial arteries and veins as a compensatory increase in blood volume through the canal of Monro [ ]. Evidence has also revealed that the incidence of post-dural puncture headaches ranges from 0 to 42.6% after spinal anesthesia and 81% after accidental puncture [ 12 ].\u003c/p\u003e \u003cp\u003eThe incidence of post-dural puncture headaches in our study was 3.5%, which is lower than in studies conducted in eastern Ethiopia, Kenya, Cairo, Egypt, and elsewhere due to the different sample sizes [ 9\u0026ndash;11 ].\u003c/p\u003e \u003cp\u003eIn these studies, needle size, number of attempts, body mass index, needle direction, and anesthesiologist experience were significantly associated with the occurrence of post-dural puncture headaches. In our studies, participants had difficulty determining the needle size used due to their lack of knowledge of the procedure.\u003c/p\u003e \u003cp\u003eRepeated attempts increase the incidence of post-dural puncture headaches by 1.5 to 4 times compared to a single attempt. In our study, the number of attempts ranged from one to two, with one case undergoing four attempts. According to Dawit et al., mothers who underwent a single spinal anesthesia had a 62.6% lower risk of developing post-dural puncture headaches than mothers who underwent multiple spinal anesthesia attempts [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. An Ethiopian study [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] reported that spinal anesthesia performed by an anesthesiologist with more than 3 years of experience reduced the incidence of post-dural puncture headaches by 56% compared to an anesthesiologist with less than 3 years of experience. This finding differs from other studies, which have shown that anesthesiologists' experience is not associated with post-dural puncture headaches. In our study, the incidence of headaches was higher when performed by an anesthesia technician than by an anesthesiologist. In our findings, a body mass index (BMI) greater than 30 kg/m\u0026sup2; increased the incidence of post-dural puncture headaches by 2.85 times. In our results, a BMI greater than 30 kg/m\u0026sup2; increased the incidence of post-dural puncture headache by 2.85 times [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study did not demonstrate an association between these factors (number of attempts, experience of the practitioner, BMI, and patient positioning during the procedure) and the incidence of post-dural puncture headache. This is primarily due to the difference in sample sizes between these studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn our study, the incidence of post-dural puncture headache was 3.5%. Studies show that factors such as needle size, number of attempts, body mass index, and anesthesiologist experience are associated with increased headache incidence. Repeated attempts were observed to increase the likelihood of headache by 1.5 to 4 times. Headache rates were higher when anesthesia was administered by an anesthesiologist compared to an anesthesiologist. Our study did not demonstrate an association between these factors and headache incidence, possibly due to the difference in sample sizes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclarations Ethical statement:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The ethical consent was obtained from Syrian private university ethical committee Competing Interest: the authors declare no competing of interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSunana Gupta N.M., Mahajan Arti, Reidwan Dar Mohd, Gupta Neeraj. Role of oral prednisolone in the management of postdural puncture headache after spinal anesthesia in urological patients. Anesth. Essays Res. 2017;11:1075\u0026ndash;1078. doi: 10.4103/0259-1162.183565. [DOI] [PMC free article] [PubMed] [Google Scholar]\u003c/li\u003e\n\u003cli\u003eAsoke Chakraborty A.S. The incidence of post dural puncture headache following spinal anaesthesia:- A comparison of sitting versus lateral decubitus position. International Journal of Contemporary Medical Research. 2016;3(7):2096\u0026ndash;2099. [Google Scholar]\u003c/li\u003e\n\u003cli\u003eChao-Jie Yang T.C., Ni Xin, Wang W-YYaW. Effect of pre-administration with aminophylline on th occurrence of post-dural puncture headache in women undergoing caesarean section by combined spinal-epidural anaesthesia. J. Int. Med. Res. 2019;47(1):420\u0026ndash;426. doi: 10.1177/0300060518803231. [DOI] [PMC free article] [PubMed] [Google Scholar]\u003c/li\u003e\n\u003cli\u003eCarrazana G.M.F.B.Y., S\u0026aacute;nchez Y.O., Pardo S.G., Zamora B.B., et al. Factors that influence the appearance of post-puncture dural headache in patients undergoing elective cesarean section. Int. J. Anesthesiol. Pain Med. 2018;5 1:1. [Google Scholar]\u003c/li\u003e\n\u003cli\u003eNaghibi K.H.M. Prophylactic administration of aminophylline plus dexamethasone reduces post-dural puncture headache better than using either drug alone in patients undergoing lower extremity surgery. Adv. Biomed. Res. 2014;3(5) doi: 10.4103/2277-9175.124631. [DOI] [PMC free article] [PubMed] [Google Scholar]\u003c/li\u003e\n\u003cli\u003eOgunbanjo O.B.O.G.A. Postdural puncture headache: evidence-based review for primary care. Afr. Family Pract. 2015;57(4):241\u0026ndash;246. [Google Scholar]\u003c/li\u003e\n\u003cli\u003eKassa Adugna Aregawi, Ba T.K., D Z.A. Post dural puncture headache (PDPH) and associated factors after spinal anesthesia among patients in university of gondar referral and teaching hospital, gondar, North west Ethiopia. J. Anesth. Clin. Res. 2015;6(6) [Google Scholar]\u003c/li\u003e\n\u003cli\u003eDina Y. Kassim a IME. Comparative study between hydrocortisone and mannitol in treatment of postdural puncture headache: a randomized double-blind study. Egypt. J. Anaesth. 2016;32:357\u0026ndash;363. [Google Scholar]\u003c/li\u003e\n\u003cli\u003eSharon L., Kracoff V.K. Post dural puncture headache\u0026mdash;review and suggested new treatment. Open J. Anesthesiol. 2016;6:148\u0026ndash;163. [Google Scholar]\u003c/li\u003e\n\u003cli\u003eMohammed A.D.A.R., Salisu, Nagoma A.U., Owolabi L.F., Ibrahim A. An analysis of postdural puncture headache in obstetric patients: a study from Kano, Nigeria. Trop. J. Obstet. Gynaecol. 2017;34:16\u0026ndash;20. [Google Scholar]\u003c/li\u003e\n\u003cli\u003eWang F. Intech; 2015. Post Dural Puncture Headache \u0026ndash; We Can Prevent it. [Google Scholar]\u003c/li\u003e\n\u003cli\u003eApfel C.C., AS, Cakmakkaya O.S., George R. Gaiser E., Radke O. Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review. Br. J. Anaesth. 2010;105(3):255\u0026ndash;263. doi: 10.1093/bja/aeq191. [DOI] [PubMed] [Google Scholar]\u003c/li\u003e\n\u003cli\u003eUma Munnur M., Suresh Maya S., Backache M.D. vol. 21. Anesthesiology Clinics of North America; 2003. pp. 71\u0026ndash;86. (Headache, and Neurologic Deficit after Regional Anesthesia). [DOI] [PubMed] [Google Scholar]\u003c/li\u003e\n\u003cli\u003eLaleh Dehghanpisheh S.B., Azemati Simin, Rakhshan Mahnaz. The effect of intravenous administration of ondansetron compared to aminophylline on incidence and severity of post-dural puncture headache (PDPH) in cesarean section surgeries. Biomed. Res. 2019;30 [Google Scholar]\u003c/li\u003e\n\u003cli\u003eSharon L., Kracoff V.K. Post dural puncture headache\u0026mdash;review and suggested new treatment. Open J. Anesthesiol. 2016;6:148\u0026ndash;163. [Google Scholar]\u003c/li\u003e\n\u003cli\u003eHeather Suescun D., CRNA, Paul Austin P., CRNA, Dion Gabaldon D., CRNA Nonpharmacologic neuraxial interventions for prophylaxis of postdural puncture headache in the obstetric patient. AANA J. February 2016;84(1) [PubMed] [Google Scholar]\u003c/li\u003e\n\u003cli\u003eKwak K.-H. Postdural puncture headache. Kor. J. Anesthesiol. 2017;70(2) doi: 10.4097/kjae.2017.70.2.136. [DOI] [PMC free article] [PubMed] [Google Scholar]\u003c/li\u003e\n\u003cli\u003eH.O. Ahmed, M. Hossam, A. Adel, Volume preload versus ephedrine infusion for prevention of hypotension due to spinal anesthesia for cesarean section, Open J. Anesthesiol. 6 (2016) 37\u0026ndash;44.\u003c/li\u003e\n\u003cli\u003eM.G. Montasser, Post dural puncture headache after spinal anesthesia for caesarean section: a comparison of 27G quincke and whitacre spinal needles in midline and paramedian approaches, J. Med. Sci. 15 (1) (2015) 44\u0026ndash;49.\u003c/li\u003e\n\u003cli\u003eM.G. Mahzad Yousefian, Comparison review of the effects of dexamethasone and ondansetron intravenous on preventing headache after spinal sedation of patients under a caesarean section in the alavi hospital, Int. J. Sci. Study 5 (3) (June 2017).\u003c/li\u003e\n\u003cli\u003elA. Shumaila Ashfaq, Muhammad Asharfzia, Rizwan Ahmad Khan, Mehatash Butt, Effect of hydrocortisone on reducing postdural puncture headache after spinal anesthsia for elective cesearean section, Ann. King Edward Med. Univ. 23 (4) (2017) 468\u0026ndash;472.\u003c/li\u003e\n\u003cli\u003eE.F. Domingos Dias Cicarelli, Fabio \u0026acute; Ely Martins Bensenor, Incidence of neurological complications and post-dural puncture headache after regional anesthesia in obstetric practice: a retrospective study of 2399 patients, Colomb. J. Anesthesiol. 42 (1) (2014) 28\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003eM.T. Mortazavi, Hydrocortisone post dural puncture headache, Arch. Anesthesiol. Crit. Care 4 (1) (2018) 426\u0026ndash;429.\u003c/li\u003e\n\u003cli\u003eI.O. Ismail Sırıt, Dilek Yazıcıoglu, Aminophylline does not prevent postdural puncture headache in caesarean section, Int. J. Anesth. Anesthesiol. 3 (3) (2015).\u003c/li\u003e\n\u003cli\u003eS.A. Noyan Ashraf Ma, Z. Azarbakht, E. Ssah, Hydrocortisone IN post-dural puncture headache, Middle East J. Anesthesiol. 19 (2) (2007).\u003c/li\u003e\n\u003cli\u003eAshraf Ragab, Khalid Noman Facharzt, Caffeine, Is it effective for prevention of postdural pun\u003c/li\u003e\n\u003cli\u003eA.M. Dawit Tafesse, Magnitude of post dural puncture headache and associated factors in obstetric mothers undergone spinal anesthesia for caesarean section, J. Anesth. Crit. Care 11 (2) (2019).\u003c/li\u003e\n\u003cli\u003eHassan Mohamed Ali, M.Y.M.Y.M. Ahmed, Postdural puncture headache after spinal anesthesia in cesarean section: experience in six months in 2736 patients in Kasr El aini teaching hospital \u0026ndash; Cairo University, Egypt. J. Anaesth. 30 (2014) 383\u0026ndash;386.\u003c/li\u003e\n\u003cli\u003ehttps://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2022/06000/incidence_and_associated_factors_of_post_dural.31.aspx#:~\u003cbr\u003e:text=5.-,Conclusion,with%20BMI%3E30%20kg%2Fm\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 100px;\"\u003e\n \u003cp dir=\"RTL\" style=\"text-align: center;\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eTable1\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e20-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e67.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e31-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e29.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e46-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinimum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd. Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e29.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e6.812\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 100px;\"\u003e\n \u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003eTable2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e18.5-24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e65.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e25-29.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e30-39.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 100px;\"\u003e\n \u003cp dir=\"RTL\" style=\"text-align: center;\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eTable3\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEconomic status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eExcellent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eVery good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e30.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e54.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 100px;\"\u003e\n \u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003eTable4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you suffer from chronic diseases?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e92.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 57px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 100px;\"\u003e\n \u003cp style=\"text-align: center;\"\u003e\u003cstrong\u003eTable5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you suffer from migraines?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e95.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 6\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you taking any\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eneurological medications?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e97.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 7\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe classification that suits\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eyour health condition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eASA1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e95.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eASA2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 57px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 8\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever had spinal anesthesia?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e48.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e51.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 9\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 55px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever experienced a headache\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eafter spinal anesthesia?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e31.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e68.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 10\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 56px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you experiencing headaches\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eafter spinal anesthesia?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e96.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 56px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 11\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePosition under anesthesia?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eSitting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e63.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eLying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e36.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 12\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of attempts?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eOnce\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eTwice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eThree times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eFour times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 13\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuccessful blockade?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e88.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 53px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 14\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 55px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcademic level of the person\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;performing the procedure?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e44.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eAnesthesia Technician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e55.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 15\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssociated symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003eneck stiffness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e15.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003eTinnitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e17.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003eDouble vision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e11.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003ePhotophobia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e7.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003eNausea and/or vomiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e48.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e100.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 16\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" style=\"width: 44px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you experiencing headaches after spinal anesthesia?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePosition under anesthesia?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003eSitting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e60.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e63.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 7px;\"\u003e\n \u003cp\u003elying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e36.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e36.90%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 31px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e96.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e100.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-Value=0.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 17\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" style=\"width: 37px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you experiencing headaches after spinal anesthesia?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of attempts?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eOnce\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e2.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e70.90%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e73.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eTwice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e1.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e21.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e22.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eThree times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e2.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eFour times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e1.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e3.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e96.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e100.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-Value=0.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 18\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" style=\"width: 48px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you experiencing headaches after spinal anesthesia?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat is the academic level\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eof the person performing\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;the procedure?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e1.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e43.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e44.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eAnesthesia Technician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e53.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e55.30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 34px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e96.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e100.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-Value=0.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" style=\"width: 44px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you experiencing headaches after spinal anesthesia?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody mass index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e18.5-24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e62.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e65.20%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e25-29.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e22.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e22.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e30-39.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.70%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e12.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e12.80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eCount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e% of Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e3.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e96.50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e100.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-Value=0.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Syrian Private University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Post-dural headache, post-spinal headache, Cesarean section","lastPublishedDoi":"10.21203/rs.3.rs-6430476/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6430476/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSpinal anesthesia is the most commonly used anesthesia technique for cesarean section with a prevalence rate of 80% \u0026minus;\u0026thinsp;95%. The most common complications of spinal anesthesia are post-dural puncture headache associated with dural puncture and cerebrospinal fluid leak.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional descriptive study was conducted in Damascus Governorate during the period from 1/11/2024 to 5/1/2025. Data from 141 patients were studied through a questionnaire distributed in paper and electronic form, containing a set of questions that serve the research objective.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOur study included 141 patients who underwent cesarean section under spinal anesthesia. Their ages ranged from 21\u0026ndash;58 years, and the most participating age group was \"20\u0026ndash;30 years\" (67.5%). Patients were classified by the American Society of Anesthesiologists (ASA): \"ASA1\" (95.7%), \"ASA2\" (4.3%). History of spinal anesthesia (48.9%). Number of attempts with a puncture needle: \"once\" (39.7%), \"twice\" (22.7%). Academic level of the person performing the spinal block: \"physician\" (44.7%), anesthesia technician (55.3%). Symptoms experienced by patients after spinal anesthesia: \"nausea/vomiting\" (48.3%), \"tinnitus\" (17.9%), \"foveal rigidity\" (15.5%), \"double vision\" (11.1%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn our study, the incidence of headache after dural puncture was 3.5%. Studies show that factors such as needle size, number of attempts, body mass index, and anesthesiologist experience are associated with increased incidence of headache. Repeated attempts were observed to increase the likelihood of headache by 1.5 to 4 times. Headache rate was higher when anesthesia was administered by an anesthesia technician than by an anesthesiologist. Our study did not show an association between these factors and headache incidence, which is attributed to the difference in sample sizes studied.\u003c/p\u003e","manuscriptTitle":"The incidence and causes of headaches after spinal anesthesia in cesarean sections","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-16 05:30:32","doi":"10.21203/rs.3.rs-6430476/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fe395354-3938-4cd0-94ba-71cb139366de","owner":[],"postedDate":"April 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":47047936,"name":"Anesthesiology \u0026 Pain Medicine"}],"tags":[],"updatedAt":"2025-04-16T05:30:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-16 05:30:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6430476","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6430476","identity":"rs-6430476","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}