The relationship between serum estrogen concentration and post-dural puncture headache: a retrospective study.

OBJECTIVE: Post-Dural puncture headache (PDPH) is a severe and undesirable complication for the patient and anesthesiologist. PDPH is more common in female patients. However, its relationship with plasma estrogen levels has not been demonstrated. This study aimed to investigate the relationship between estrogen levels and PDPH in patients who underwent spinal anesthesia for in vitro fertilization (IVF) with supraphysiological estrogen levels.

PATIENTS AND METHODS: In this retrospective study, the data of patients between the ages of 18-45 with the following characteristics were included in the study: those who underwent IVF procedure between January 2021 and August 2022, in the ASA I-II risk group, and who underwent spinal anesthesia using a 25 G Quinke-tipped spinal needle at the L3-L4 or L4-L5 vertebra levels. The 48 patients in the study were in two groups according to their estradiol values: 'Supra physiological estradiol levels' (Group I=24 patients) and 'Normal estradiol levels' (Group C=24 patients). The relationship between PDPH and estrogen, progesterone, spinal needle diameter, and patient demographic characteristics were evaluated.

RESULTS: The estrogen and progesterone levels of patients in Group I were higher than in Group C (p<0.001 and p<0.001, respectively). PDPH was present in 6 (25%) patients in Group I and 5 (20.8%) patients in Group C (p=0.731). There was no significant correlation between PDPH and estrogen and progesterone levels (p>0.05).

CONCLUSIONS: Since there is no relationship between the supraphysiological estrogen level and PDPH, high serum estrogen level should not be considered as an additional risk factor for PDPH in the decision of anesthesia type for IVF procedure.