Role of Oral Prednisolone in the Management of Postdural Puncture Headache after Spinal Anesthesia in Urological Patients

The Effect of Sumatriptan, Theophylline, Pregabalin and Caffeine on Prevention of Headache Caused By Spinal Anaesthesia (PDPH): A Systematic Review

Spinal anaesthesia (SA) is a common method during surgery due to easy administration, rapid effects, relaxes muscles and controls pain. But, post-dural puncture headache (PDPH) is a common problem after SA that occurs in 6%-36% of SA. We assessed the effect of four common treatment drugs sumatriptan, theophylline, pregabalin and oral caffeine on prevention of PDPH. In this systematic review, all randomized clinical trials (RCTs) during January 2015 and December 2021 were searched from PubMed, Google Scholar, Web of Science, Cochrane review and Clinical Key with a specific search strategy. The article qualities were assessed by two independent authors and were screened for relevant sources based on inclusion and exclusion criteria. Moreover, the included articles data were extracted and checked for regular basis. A total of 421 articles were identified and 193 articles were removed following a preliminary review and finally, 14 articles were included in review. Overall, we identified five RCTs on the effect of caffeine, two RCTs on the effect of sumatriptan, three RCTs on theophylline, three RCTs on pregabalin and one RCT on theophylline and sumatriptan in PDPH prevention. This review supports the effects of theophylline, pregabalin and sumatriptan in the prevention of PDPH incidence and treatment of PDPH intensity, but we cannot draw the same conclusions about caffeine due to some negative results about the caffeine effect. Nevertheless, this extracted conclusion should be considered and interpreted with caution and limited generalizations due to the small number of studies, the variety of evaluated drugs and measures, the low sample size and the bias presented.

Incidence and associated factors of post dural puncture headache in cesarean section done under spinal anesthesia 2021 institutional based prospective single-armed cohort study

Background

Spinal anesthesia is the most commonly used anesthesia technique for Cesarean delivery with 80%–95% prevalence. The most common complication of SA is post-dural puncture Headache which is associated with dural puncture & Cerebrospinal fluid leak. This study aimed to assess the incidence and associated factors of post-dural puncture headache.

Methods

single-armed cohort study design was employed on 412 women from May 2021 to January 2022. Study subjects were selected using systematic random sampling. Descriptive statistics for each variable, binary logistic regression, and multiple logistic regression analysis with 95% CI was carried out.

Results

The overall incidence of post-dural puncture headache in this study was 25.7%. 43.9% of Post dural headache was detected in the 1st 24 h followed by 48 h. Of those who develop Post-dural headaches, 54.1% of them had mild pain, 17.3% of them was moderate pain and 28.6% of them suffered severe pain. The multivariable analysis indicated that BMI>30 kg/m² [AOR 2.85 95% CI: 1.91–4.25], number of attempts (>3), (AOR = 1.5, 95% CI: 1.19–1.91), and cephalic needle direction (AOR = 5.79 95% CI: 2.27–12.22), were factors associated with increased post-dural puncture headache. While large gauge needle size (AOR = 0.28 95% CI: 0.19–0.42), and greater than 3 years of experience of anesthetist (AOR = 0.44, 95% CI: 0.31–0.62) were associated with decreased incidence of post-dural puncture headache.

Conclusion

The incidence of post-dural puncture headache was higher in BMI>30 kg/m², greater than 3-time attempts during spinal anesthesia, using low gauge spinal needles, less than 3 years of experience as anesthetist and cephalic needle direction.

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Incidence of post-dural puncture headache was 25.7% of this 43.9% of PDPH happen in the first 24 h.

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54.1% of mothers who develop PDPH had mild pain while 17.3% and 28.6% of them suffered moderate and severe pain respectively.

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Large size spinal needle, greater than 3 attempts, cephalic needle direction, BMI >30 kg/m², and experience of anesthetist less than 3 years' were factors associated with increased incidence of PDPH.