Question

Create Your Own Performance Measure:  The surgical floor has anecdotally noticed that patients who have received a spinal anesthetic are complaining more and more frequently of severe, persistent headache within four hours of surgery. The anesthesia department has decided that this needs further investigation. It is well established in the literature that spinal headaches can be avoided with proper education of staff and patients.

1. How can the anesthesia department establish whether a problem exists?

2. Develop a measurable statement that can be used to determine desired performance regarding spinal anesthetic and headache.

3. Create a sample data display of a report you would like to see of these results for the last twelve months.

Answer 1

1. The medication is injected into the spinal canal to numb the nerves during the spinal anaesthesia. A spinal headache develops when the spinal fluids is leaked from the pucture site. Spinal headache to be taken as a serious if it exists more than 24hours after the surgery. The headache worsens if the sit or stand up due to increased pressure on the puncture site. Additionally increased CSF protein and increased CSF Lymphocyte count may confirm the diagnosis of post punctural headache.

2. The principle factor that must be considered in spinal anaethesia is the size of the needle and the dural perforation. Use of large needles will increases the headache. Technical failure in the use of needle results in high dural puncture headache. Optimal needle size with exact design reduces the risk of headache.

3. Sample Data of spinal anaethesia and the headache in the last tweleve months

About 116 Patients who undergone spinal anesthesia for the purpose of surgery were included in the sample report.

Based on the Size of the Needle:

Needle size used	PDPH		% of patients with PDPH
	Yes	No
18G	7	4	63.60%
20G	24	25	49%
22G	9	20	31%
24G	4	11	26.60%
<24G (25,26&27)	1	11	8.30%