Effect of different work-time periods on the incidence of post-dural puncture headache in cesarean section patients at King Abdullah University Hospital

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