Effect of Altitude on Postdural Puncture Headache After Caesarean Delivery

This will be a prospective cohort study conducted in two different altitudes in Nepal. The high-altitude site is in Jumla, approximately 2514 m above the sea level, and a low altitude city is Dharan, located at 350 m from sea level.

The investigators will screen the eligible participant admitted to the in-patient obstetric unit. The investigator will also record patient baseline characteristics, preoperative anxiety, antenatal depression, presence of chronic pain conditions or preexisting headache. Spinal anaesthesia will be administered in the sitting position at the L3-L4 or L4-L5 interspace using a 25-G pencil point spinal needle (Pencan® 25-gauge).

The diagnosis of post-dural puncture headache will be based on the international headache society ICDH-3 criteria

Inclusion criteria

• Parturient, aged more than or equal to 18 years
• American society of Anesthesiologist 2 and 3
• Scheduled for elective and non-elective (category 2 & 3) caesarean delivery with spinal anesthesia
• Native to their resident altitude i.e., those born, raised, and have continuously lived at the same altitude, at least for the past 1 year.

Exclusion criteria

• Hypertensive disorder
• Cerebrovascular disease
• Mental disorder (schizophrenia and other psychotic disorders)
• Known fetal anomalies
• Contraindication to spinal anaesthesia.
• Those requiring general anaesthesia for delivery due to failed spinal anesthesia
• Major post-delivery complications (severe haemorrhage, sepsis, or ICU admission)
• Those who migrate from their resident altitude (either low to high or vice versa) within 7 days post-delivery will also be excluded.