The Efficacy of Prophylactic Intravenous Aminophylline, Paracetamol or Aminophylline and Paracetamol in Prevention of Headache Strikes Due to Spinal Anesthesia in Cesarean Sections Compared to the Control Group

Document Type : Original Article (s)

Authors

1 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Post-dural-puncture headache (PDPH) is commonly seen after neuroaxial block and several types of regimens have been suggested for treatment. This study aimed to evaluate the effects of aminophylline, paracetamol and administration of aminophylline and paracetamol concurrently on prevention of post-dural-puncture headache.Methods: In a double-blind randomized clinical trial, we evaluated 136 patients in four groups (n = 34) undergoing spinal anesthesia for elective cesarean section in Shahid Beheshti and Alzahra hospitals of Isfahan province, Iran, during March to December 2015. After umbilical cord clamping, in four group aminophylline (1.5 mg/kg), paracetamol (12.5 mg/kg), aminophylline and paracetamol with the same dose and normal saline was injected slowly intravenously. Before spinal anesthesia, each 15 minutes during execute time of surgery and in recovery room, every 6 hours in first day and daily in first weak after the surgery, incidence of post-dural-puncture headache in each group was evaluated.Findings: 42 patients (33.88%) out of the 136 ones suffered from headache. 26.5% of patients who had received aminophylline, 32.4% of patients who had received paracetamol, 14.7% of patients who had received aminophylline and paracetamol and 50% of patients who had not received any drug suffered from headache (P = 0.007).Conclusion: This study shows that intravenous administration of aminophylline and paracetamol significantly reduces the incidence of post-dural-puncture headache in cesarean section and we can use this regimen for prevention.

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  1. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 2003; 91(5): 718-29.
  2. Miller RD. Miller's anesthesia. 6th ed. Phladelphia, PA: Churchill Livingstone; 2004. p. 2316-8.
  3. Greene BA. A 26 gauge lumbar puncture needle: its value in the prophylaxis of headache following spinal analgesia for vaginal delivery. Anesthesiology 1950; 11(4): 464-9.
  4. Greene HM. A technique to reduce the incidence of headache following lumbar puncture in ambulatory patients with a plea for more frequent examination of cerebrospinal fluids. Northwest Medical Journal 1923; 22: 240-2.
  5. Hart JR, Whitacre RJ. Pencil-point needle in prevention of postspinal headache. J Am Med Assoc 1951; 147(7): 657-8.
  6. Tarrow AB. Solution to spinal headaches. Int Anesthesiol Clin 1963; 1(3): 877-88.
  7. Halpern S, Preston R. Postdural puncture headache and spinal needle design. Metaanalyses. Anesthesiology 1994; 81(6): 1376-83.
  8. Kuntz KM, Kokmen E, Stevens JC, Miller P, Offord KP, Ho MM. Post-lumbar puncture headaches: experience in 501 consecutive procedures. Neurology 1992; 42(10): 1884-7.
  9. Morewood GH. A rational approach to the cause, prevention and treatment of postdural puncture headache. CMAJ 1993; 149(8): 1087-93.
  10. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Miller's anesthesia. 8th ed. Philadelphia, PA: Saunders; 2014.
  11. Abdulla S, Abdulla W, Eckhardt R. Caudal normal saline injections for the treatment of post-dural puncture headache. Pain Physician 2011; 14(3): 271-9.
  12. Fournet-Fayard A, Malinovsky JM. Post-dural puncture headache and blood-patch: theoretical and practical approach. Ann Fr Anesth Reanim 2013; 32(5): 325-38. [In French].
  13. Kuczkowski KM. Post-dural puncture headache in the obstetric patient: an old problem. New solutions. Minerva Anestesiol 2004; 70(12): 823-30.
  14. Kshatri AM, Foster PA. Adrenocorticotropic hormone infusion as a novel treatment for postdural puncture headache. Reg Anesth 1997; 22(5): 432-4.
  15. Frank RL. Lumbar puncture and post-dural puncture headaches: implications for the emergency physician. J Emerg Med 2008; 35(2): 149-57.
  16. Yucel A, Ozyalcin S, Talu GK, Yucel EC, Erdine S. Intravenous administration of caffeine sodium benzoate for postdural puncture headache. Reg Anesth Pain Med 1999; 24(1): 51-4.
  17. Ergun U, Say B, Ozer G, Tunc T, Sen M, Tufekcioglu S, et al. Intravenous theophylline decreases post-dural puncture headaches. J Clin Neurosci 2008; 15(10): 1102-4.
  18. Goldstein J, Hoffman HD, Armellino JJ, Battikha JP, Hamelsky SW, Couch J, et al. Treatment of severe, disabling migraine attacks in an over-the-counter population of migraine sufferers: results from three randomized, placebo-controlled studies of the combination of acetaminophen, aspirin, and caffeine. Cephalalgia 1999; 19(7): 684-91.
  19. Sadeghi SE, Abdollahifard G, Nasabi NA, Mehrabi M, Safarpour AR. Effectiveness of single dose intravenous aminophylline administration on prevention of post dural puncture headache in patients who received spinal anesthesia for elective cesarean section. World J Med Sci 2012; 7(1): 13.
  20. Yucel A, Ozyalcin S, Talu GK, Yucel EC, Erdine S. Intravenous administration of caffeine sodium benzoate for postdural puncture headache. Reg Anesth Pain Med 1999; 24(1): 51-4.
  21. Esmaoglu A, Akpinar H, Ugur F. Oral multidose caffeine-paracetamol combination is not effective for the prophylaxis of postdural puncture headache. J Clin Anesth 2005; 17(1): 58-61.
  22. Masoudifar M, Aghadavoudi O, Adib S. Effect of venous dexamethasone, oral caffeine and acetaminophen on relative frequency and intensity of postdural puncture headache after spinal anesthesia. Adv Biomed Res 2016; 5: 66.