Evaluation of the Reverse Flow Technique in Prevention of Post Dural Puncture Headache in Cesarean Sectionunder Spinal Anesthesia

Post Dural Puncture Headache (PDPH) is a relatively common complication after spinal or epidural anesthesia, myelography and lumbar puncture. Despite numerous studies that have identified many therapies, debate and survey continues on the best technique to prevent this complication. Therefore, the purpose of this study was to evaluate the ''Reverse Flow" technique in prevention of headache after dural puncture in cesarean section under spinal anesthesia.
In this single blind, simple randomized clinical trial, patients were divided to two groups: intervention and control. Each group constituted of 120 patients. In the intervention group we mixed 3 mL Marcaine 0.5% with 1 cc fentanyl and injected 3 mL of this mixture into subarachnoid space by 24-gauge quincke spinal needle then simultaneously with injection of 1mL of this mixture, the needle was withdrawn. In the control group only 3 mL of this was mixture was injected into subarachnoid space and we had no injection while needle withdrawing. Then we evaluated headache at 6, 12, 18, 24, 48 and 72 hours after the operation and if patients had headache we determined severity of pain with the Numerical Rating Scale.
Incidence of headache in the intervention group was 2.5% and 9.2% in the control group (P = 0.028). The average severity of headache was 5.66 ± 3.21 in the intervention group and 5.18 ± 2.89 in the control group (P = 1). The mean age was 29.26 ± 5.95 in the control group and 27.89 ± 5.58 in the intervention group (P = 0.066). The mean age in patients, who suffered from headache, was 24.66 ± 3.05 in the intervention group and 29.72 ± 6.54 in the control group (P = 0.23). Patients who complained of headaches were younger than others.
This study indicated that use of "Reverse Flow" technique in cesarean section under spinal anesthesia reduces PDPH. The incidence of PDPH in patients, who have not received this technique, was 3/7 times more than patients, who have received this technique. Also the onset of headache in the control group happened earlier than in the case group.