In 1885, Dr. JL Corning¹ wrote the first paper about spinal anesthesia and said, ‘Whether the method will ever find an application as a substitute for etherization in genito-urinary or other branches of surgery, further experience alone can show’. He might have been defined the very first post-dural puncture headache (PDPH) in that first report of the spinal anesthesia application, instead of August Bier. In 1956 it was reported that the incidence of PDPH was varied between 15% to 46%.² And current reports show that the incidence of unintended dural puncture (DP) is between 0,16%-1,3%, and the incidence of PDPH after DP ranges between 16% to 86%.³ This means that the ‘so-called problem’ occurred in 0,02%-1,1% of the patients. But is this a problem or a complication that can be overcome?

It is known that the development of PDPH depends on several factors related to the patient, the technique, and the needle type.⁴ Pirbudak et al.⁵ showed that the physician’s experience and physical state/fatigue are strongly correlated to the incidence of PDPH along with other well-known factors. So this leads us to think that ‘the problem’ is not PDPH itself, but might be the lack of experience, lack of knowledge for both prevention and treatment, and improper technique or needle.

Today, when we search for ‘spinal anesthesia’ on Pubmed, nearly 28000 results can be found. Some of these are about the complications like PDPH, but most are about the benefits of the technique. One way or other, since its first definition, the technique has found its place in daily clinical practice as a standard procedure. I have two questions: If PDPH is a real problem, why do the clinicians continue to perform spinal anesthesia. And is it really a problem, as there are many solutions?

Reference

1. Corning JL. Spinal anaesthesia and local medication of the cord. New York Medical Journal 1885;42:483–5.

2. Rosedale N. Lumbar puncture headache in relation to age of patient and rest after puncture. Br J Vener Dis 1956;32:127–8.

3. Giaccari LG, Aurilio C, Coppolino F, et al. Peripheral Nerve Blocks for Postdural Puncture Headache: A New Solution for an Old Problem?. In vivo 2021;35:3019–29

4. Patel R, Urits I, Orhurhu V, et al. A Comprehensive Update on the Treatment and Management of Postdural Puncture Headache. Curr Pain Headache Rep 2020;24:24.

5. Pirbudak L, Ozcan HI, Tumturk P. Postdural puncture headache: incidence and predisposing factors in a university hospital. Agri 2019;31:1–8.