Efficacy and safety of the lumbosacral anatomical technique in obstetric patients
Keywords:
post dural puncture headache; obstetric anesthesia; lumbosacral level; spinal anesthesia; anesthetic complications.Abstract
Introduction: post‑dural puncture headache is a frequent complication in obstetric neuraxial anesthesia, with an internationally reported incidence ranging from 1% to 40%. In Cuba, it represents a clinical challenge that affects postpartum recovery and increases the demand for healthcare resources.
Objective: to evaluate the efficacy and safety of the lumbosacral intrathecal approach (L5‑S1) for preventing post‑dural puncture headache in obstetric patients undergoing cesarean section.
Methods: A prospective comparative analytical observational study of parallel groups was conducted with 200 patients distributed into two groups: intervention (L5‑S1 puncture) and control (L4‑L5 puncture). A 22‑gauge Whitacre needle with hyperbaric 0.5% lidocaine was used. Incidence of PDPH, anesthetic efficacy, and safety were assessed.
Results: the incidence of post‑dural puncture headache was 0% in the L5‑S1 group versus 40% in the L4‑L5 group (p<0.001). There were no differences in anesthetic efficacy between the groups. The Number Needed to Treat was 2.5.
Conclusions: the lumbosacral approach (L5‑S1) proved to be highly effective in preventing post‑dural puncture headache without compromising anesthetic efficacy, representing a safe and reproducible anatomical strategy in obstetric anesthesia.
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Copyright (c) 2026 Zaily Fuentes Díaz, Orlando Bismark Rodríguez Salazar, Mairelis Matamoros Proenza
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