Comparison between Nalbuphine and Ketamine as an Adjuvant to Heavy Bupivacaine on Post Dural Puncture Headache

Abstract

Post dural puncture headache (PDPH) is one of the most common complications of spinal anesthesia and it is defined as any headache after lumber puncture that worsens within 15 minutes of sitting position and it is relieved within 15 minutes of lying down. About 90% of post dural puncture headache occurs within 3 days of the procedure and about 66% start in the first 48 hours (Balestrieri, 2003). Incidence of post dural puncture headache is directly related to the needle diameter that pierces the dura mater, so smaller diameter needle will be used to decrease risk of post dural puncture headache (Lambart et al., 1997).