Comparison of the Effect of Dexamethasone, Acetaminophen, and Normal Saline on the Prevention of Headache in Patients under Elective Cesarean Section

Document Type : Original Article (s)

Authors

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

2 Assistant Professor, Anesthesiology and Critical Care Research center, Isfahan University of Medical Sciences, Isfahan, Iran

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

Abstract

Background: One of the most prevalent problems in patients under surgeries with spinal anesthesia is postoperative headache; despite several studies, no optimal method is recommended for prevention of this problem. This study aimed to compare the effect of dexamethasone, acetaminophen, and normal saline on the prevention of headache in patients under elective cesarean section.Methods: In a clinical trial study, 135 patients under cesarean section were randomly divided in three equal groups. 15 minutes before the termination of surgery, patients received 8 mg dexamethasone, 1 g acetaminophen, or the same volume of normal saline, respectively. The incidence and intensity (visual analog scale or VAS) of headache after spinal anesthesia was compared between the three groups.Findings: The mean headache intensity was 8.3 ± 7.4, 11.1 ± 2.9, and 19.3 ± 5.7 in dexamethasone, acetaminophen, and normal saline groups, respectively, and the difference between the three groups was statistically significant (P < 0.001). Incidence of headache was 3 (6.7%), 5 (11.1%) and 9 (20.5%) in dexamethasone, acetaminophen, and normal saline groups, respectively, and no statistically difference was seen between the groups (P = 0.140).Conclusion: Preemptive dexamethasone and acetaminophen had a considerable effect on the prevention of post-spinal-anesthesia headache but there is not any difference between dexamethasone and acetaminophen. As using dexamethasone in some patients is limited and may lead to some complications such as hyperglycemia, hormone abnormality, and gastrointestinal bleeding, using acetaminophen is proffered.

Keywords


  1. Shakeri M, Shakibazadeh E, Arami R, SoleimaniM. Cesarean delivery on maternal request in Zanjan, Iran. Life Sci 2013; 10(1):1308-11.
  2. Miri Farahani L, Abbasi Shavazi M J. Caesarean section change trends in Iran and some demographic factors associated with them in the past three decades. J Fasa Univ Med Sci 2012; 2(3): 127-34. [In Persian].
  3. Hawkins JL, Koonin LM, Palmer SK, Gibbs CP. Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology 1997; 86(2): 277-84.
  4. Afolabi BB, Lesi FE, Merah NA. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev 2006; (4): CD004350.
  5. Etezadi F, Yousefshahi F, Khajavi M, Tanha F, Dahmarde A, Najafi A. post dural puncture headache after cesarean section, a teaching hospital experience. J Fam Reprod Health 2012; 6(1): 17-21. [In Persian].
  6. Najafi A, Emami S, Khajavi M, Etezadi F, Imani F, Lajevardi M, et al. Is epidural dexamethasone effective in preventing postdural puncture headache? Acta Anaesthesiol Taiwan 2014; 52(3): 95-100.
  7. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 2003; 91(5): 718-29.
  8. Yang B, Li DL, Dong P, Zhang XY, Zhang L, Yu JG. Effect of dexamethasone on the incidence of post-dural puncture headache after spinal anesthesia: a randomized, double-blind, placebo-controlled trial and a meta-analysis. Acta Neurol Belg 2015; 115(1): 59-67.
  9. Tavakol K, Ghaffari P, Hassanzadeh A. Study of the effect of dexamethasone and normal saline in reducing headache after spinal anesthesia in cesarean section. Armaghane-Danesh 2007; 87(94). [In Persian].