Comparing the Effect of Paracetamol, Dexamethasone, and Paracetamol plus Dexamethasone on Prevention of Postoperative Headache in Pregnant Women Undergoing Cesarean Section with Spinal Anesthesia

Document Type : Original Article (s)

Authors

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

2 Resident, Department of Anesthesiology and Critical Care, School of Medicine. Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: This study aimed to compare the effect of paracetamol, dexamethasone, and paracetamol plus dexamethasone on prevention of postoperative headache in pregnant women undergoing cesarean section with spinal anesthesia.Methods: In this clinical trial study, 220 pregnant women who were candidate for cesarean section under spinal anesthesia were randomly divided in 4 groups of 55 receiving 1 g paracetamol, 8 mg dexamethasone, 1 g paracetamol plus 8 mg dexamethasone, or the same volume of normal saline. The incidence of postoperative headache were compared between the 4 groups.Findings: 6 hours after the operation, frequency of postoperative headache in the paracetamol, dexamethasone, paracetamol plus dexamethasone, and control groups was 23.60, 20.00, 10.90, and 40.00 percent, respectively (P = 0.004). 12 hours after the surgery, these amounts were 25.15, 20.00, 10.90, and 40.00 percent, respectively (P = 0.004); and 24 hours after the surgery, they were 21.80, 20.00, 10.90, and 34.50 percent, respectively (P = 0.027).Conclusion: Using combination of paracetamol plus dexamethasone is more effective. Considering low effect of paracetamol for prevention of postoperative headache and also side-effects of high dose of dexamethasone, it seems that using combination of the two drugs is better for prevention of postoperative headache.

Keywords


  1. Bradbury CL, Singh SI, Badder SR, Wakely LJ, Jones PM. Prevention of post-dural puncture headache in parturients: A systematic review and meta-analysis. Acta Anaesthesiol Scand 2013; 57(4): 417-30.
  2. Kara I, Ciftci I, Apiliogullari S, Arun O, Duman A, Celik JB. Management of postdural puncture headache with epidural saline patch in a 10-year-old child after inguinal hernia repair: a case report. J Pediatr Surg 2012; 47(10): e55-e57.
  3. Kuczkowski KM. The management of accidental dural puncture in pregnant women: What does an obstetrician need to know? Arch Gynecol Obstet 2007; 275(2): 125-31.
  4. Stendell L, Fomsgaard JS, Olsen KS. There is room for improvement in the prevention and treatment of headache after lumbar puncture. Dan Med J 2012; 59(7): A4483.
  5. Kleine-Bruggeney M, Kranke P, Stamer UM. Prophylaxis and therapy of postdural puncture headache--a critical evaluation of treatment options. Anasthesiol Intensivmed Notfallmed Schmerzther 2011; 46(7-8): 516-24. [In German].
  6. Amorim JA, Gomes de Barros MV, Valenca MM. Post-dural (post-lumbar) puncture headache: Risk factors and clinical features. Cephalalgia 2012; 32(12): 916-23.
  7. Basurto O, X, Martinez GL, Sola I, Bonfill C, X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev 2011; (8): CD007887.
  8. Kuczkowski KM. Post-dural puncture headache in the obstetric patient: An old problem. New solutions. Minerva Anestesiol 2004; 70(12): 823-30.
  9. Imarengiaye C, Ekwere I. Postdural puncture headache: a cross-sectional study of incidence and severity in a new obstetric anaesthesia unit. Afr J Med Med Sci 2006; 35(1): 47-51.
  10. Shah P, Thomas S. Post–Lumbar Puncture Headache. Hospital Physician 2007; 43: 51-5.
  11. Anderson M. The properties of aminophylline. Emerg Nurse 2007; 15(7): 24-7.
  12. Donaldson D, Sundermann R, Jackson R, Bastani A. Intravenous dexamethasone vs placebo as adjunctive therapy to reduce the recurrence rate of acute migraine headaches: A multicenter, double-blinded, placebo-controlled randomized clinical trial. Am J Emerg Med 2008; 26(2): 124-30.
  13. Noyan Ashraf MA, Sadeghi A, Azarbakht Z, Salehi S, Hamediseresht E. Evaluation of intravenous hydrocortisone in reducing headache after spinal anesthesia: a double blind controlled clinical study [corrected]. Middle East J Anaesthesiol 2007; 19(2): 415-22.
  14. 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.
  15. Doroudian MR, Norouzi M, Esmailie M, Tanhaeivash R. Dexamethasone in preventing post-dural puncture headache: a randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Belg 2011; 62(3): 143-6.
  16. Basurto O, X, Uriona Tuma SM, Martinez Garcia L, Sola I, Bonfill Cosp X. Drug therapy for preventing post-dural puncture headache. Cochrane Database Syst Rev 2013; (2): CD001792.
  17. Naghibi K, Hamidi M. Prophylactic administration of aminophylline plus dexamethasone reduces post-dural puncture headache better than using either drug alone in patients undergoing lower extremity surgery. Adv Biomed Res 2014; 3: 5.
  18. 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.