EVALUATING SPINAL ANESTHESIA POSITIONING TO REDUCE POST-DURAL PUNCTURE HEADACHE IN OBSTETRICS: A META-ANALYSIS

Abstract

Post-dural puncture headache (PDPH) is a common and debilitating complication of spinal anesthesia in obstetric patients, particularly after Cesarean section. This meta-analysis evaluated whether patient position during spinal needle insertion influences PDPH incidence.

Methods: In accordance with PRISMA 2020, we systematically identified randomized controlled trials (RCTs) comparing lateral decubitus versus sitting position during spinal anesthesia in obstetric patients. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Cochrane RoB 2.0. Pooled risk ratios (RRs) were calculated using a random-effects (Der Simonian–Laird) model. Statistical heterogeneity was assessed using χ² and I². Publication bias was explored using funnel plot inspection and Egger’s test, with trim-and-fill used for adjusted estimates.

Results: Six RCTs (N=1011) were included. Lateral decubitus positioning significantly reduced PDPH compared with sitting position (RR 0.29, 95% CI 0.17–0.49, p<0.0001), corresponding to a 71% relative risk reduction. Heterogeneity was low to moderate (I²=26.0%). Egger’s test suggested small-study effects/publication bias (p=0.005). After trim-and-fill (three imputed studies), the effect remained statistically significant but attenuated (RR 0.40, 95% CI 0.23–0.69).

Conclusions: Lateral decubitus positioning during spinal anesthesia is associated with a significantly lower risk of PDPH in obstetric patients undergoing Cesarean section. However, the presence of publication bias and methodological limitations in included studies reduces certainty in the magnitude of effect. Larger, high-quality RCTs are needed to confirm benefit and clarify effect modifiers.