Document Type : Original Article(s)
Authors
- Seyed Mohammad Reza Hadavi 1
- Ashkan Panah 1
- Sona Shamohammadi 2
- Fatemeh Kanaani Nejad 1
- Mohammad Ali Sahmeddini 1
- Naeimehossadat Asmarian 1
1 Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract
Background: Post-dural puncture headache (PDPH) is the most common complication following spinal anesthesia among parturients undergoing cesarean section surgery. The purpose of this study was to evaluate the effectiveness of acetaminophen and caffeine in preventing PDPH.
Methods: This double-blind, randomized clinical trial was conducted on 96 obstetric women, who were candidates for elective cesarean section. Following the randomization of participants into two groups, participants in the intervention group received tablets of acetaminophen (500 mg)+caffeine (65 mg), and participants in the control group received placebo tablets orally 2 hours before spinal anesthesia induction and then every 6 hours after surgery up to 24 hours. All parturients were evaluated for frequency and intensity of PDPH every 6 hours until 24 hours after surgery and then 48 and 72 hours after surgery. Overall satisfaction during the first 72 hours of postpartum was evaluated. The data were analyzed using SPSS software. P<0.05 was considered statistically significant.
Results: Participants in the intervention group were 70% less likely to experience PDPH after spinal anesthesia (OR=0.31 P=0.01, 95% CI [0.12-0.77]). They also experienced significantly milder headaches 18 hours, 48 hours, and 72 hours later. Participants in the intervention group reported higher levels of satisfaction at the end of the study (P=0.01). No side effects related to the intervention were reported.
Conclusion: Prophylactic administration of acetaminophen+
caffeine decreases 70% the risk of PDPH and significantly attenuates pain intensity in obstetric patients who underwent spinal anesthesia for cesarean section.
Keywords
- Hermanns H, Bos EME, van Zuylen ML, Hollmann MW, Stevens MF. The Options for Neuraxial Drug Administration. CNS Drugs. 2022;36:877-96. doi: 10.1007/s40263-022-00936-y. PubMed PMID: 35836037; PubMed Central PMCID: PMCPMC9345828
- Uppal V, Retter S, Casey M, Sancheti S, Matheson K, McKeen DM. Efficacy of Intrathecal Fentanyl for Cesarean Delivery: A Systematic Review and Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis. Anesth Analg. 2020;130:111-25. doi: 10.1213/ANE.0000000000003975. PubMed PMID: 30633056.
- Uppal V, McKeen DM. Strategies for prevention of spinal-associated hypotension during Cesarean delivery: Are we paying attention? Can J Anaesth. 2017;64:991-6. doi: 10.1007/s12630-017-0930-0. PubMed PMID: 28702819.
- Olawin AM, J MD. Spinal Anesthesia. StatPearls. 2024. PubMed PMID: 30725984.
- Plewa MC, McAllister RK. Postdural Puncture Headache. StatPearls. 2024. PubMed PMID: 28613675.
- Carrazana GF, Bazán Y, Sánchez Y, Pardo SG, Zamora B. Factors that influence the appearance of dural post-puncture headache in patients undergoing elective cesarean section. Int J Anesthesiol Pain Med. 2019;5:1. doi: 10.36648/2471-982X.5.1.25.
- Girma T, Mergia G, Tadesse M, Assen S. Incidence and associated factors of post dural puncture headache in cesarean section done under spinal anesthesia 2021 institutional based prospective single-armed cohort study. Ann Med Surg (Lond). 2022;78:103729. doi: 10.1016/j.amsu.2022.103729. PubMed PMID: 35600186; PubMed Central PMCID: PMCPMC9121279.
- Riveros Perez E, Sanchez MG, Rocuts A, Jimenez E. Use of a Triple Prophylactic Strategy to Prevent Post-dural Puncture Headache: An Observational Study. Cureus. 2020;12:e7052. doi: 10.7759/cureus.7052. PubMed PMID: 32219046; PubMed Central PMCID: PMCPMC7086110.
- Stein MH, Cohen S, Mohiuddin MA, Dombrovskiy V, Lowenwirt I. Prophylactic vs therapeutic blood patch for obstetric patients with accidental dural puncture--a randomised controlled trial. Anaesthesia. 2014;69:320-6. doi: 10.1111/anae.12562. PubMed PMID: 24641638.
- Hakim SM. Cosyntropin for prophylaxis against postdural puncture headache after accidental dural puncture. Anesthesiology. 2010;113:413-20. doi: 10.1097/ALN.0b013e3181dfd424. PubMed PMID: 20613476.
- Guglielminotti J, Landau R, Li G. Major Neurologic Complications Associated With Postdural Puncture Headache in Obstetrics: A Retrospective Cohort Study. Anesth Analg. 2019;129:1328-36. doi: 10.1213/ANE.0000000000004336. PubMed PMID: 31335402; PubMed Central PMCID: PMCPMC9924132.
- Sachs A, Smiley R. Post-dural puncture headache: the worst common complication in obstetric anesthesia. Semin Perinatol. 2014;38:386-94. doi: 10.1053/j.semperi.2014.07.007. PubMed PMID: 25146108.
- Bateman BT, Cole N, Sun-Edelstein C, Lay CL [Internet]. Post dural puncture headache. [cited 12 September 2023]. Available from: https://www.uptodate.com/contents/post-dural-puncture-headache
- Kassa AA, Beyen T, Denu Z. Post dural puncture headache (PDPH) and associated factors after spinal anesthesia among patients in University of Gondar Referral and Teaching Hospital, Gondar, North West Ethiopia. J Anesth Clin Res. 2015;6:2. doi: 10.4172/2155-6148.1000536.
- Kwak KH. Postdural puncture headache. Korean J Anesthesiol. 2017;70:136-43. doi: 10.4097/kjae.2017.70.2.136. PubMed PMID: 28367283; PubMed Central PMCID: PMCPMC5370299.
- Basurto Ona X, Osorio D, Bonfill Cosp X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev. 2015;2015:CD007887. doi: 10.1002/14651858.CD007887.pub3. PubMed PMID: 26176166; PubMed Central PMCID: PMCPMC6457875
- Tien JC, Lim MJ, Leong WL, Lew E. Nine-year audit of post-dural puncture headache in a tertiary obstetric hospital in Singapore. Int J Obstet Anesth. 2016;28:34-8. doi: 10.1016/j.ijoa.2016.06.005. PubMed PMID: 27641087.
- Mahoori A, Hassani E, Noroozinia H, Javaheri N, Hatami S. Theophylline versus acetaminophen in the treatment of post-dural puncture headache (PDPH). Middle East J Anaesthesiol. 2013;22:289-92. PubMed PMID: 24649785.
- Mahoori A, Noroozinia H, Hasani E, Saghaleini H. Comparing the effect of pregabalin, gabapentin, and acetaminophen on post-dural puncture headache. Saudi J Anaesth. 2014;8:374-7. doi: 10.4103/1658-354X.136436. PubMed PMID: 25191190; PubMed Central PMCID: PMCPMC4141388.
- Zeger W, Younggren B, Smith L. Comparison of cosyntropin versus caffeine for post-dural puncture headaches: A randomized double-blind trial. World J Emerg Med. 2012;3:182-5. doi: 10.5847/wjem.j.issn.1920-8642.2012.03.004. PubMed PMID: 25215060; PubMed Central PMCID: PMCPMC4129783.
- Halker RB, Demaerschalk BM, Wellik KE, Wingerchuk DM, Rubin DI, Crum BA, et al. Caffeine for the prevention and treatment of postdural puncture headache: debunking the myth. Neurologist. 2007;13:323-7. doi: 10.1097/NRL.0b013e318145480f. PubMed PMID: 17848873.
- 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;17:58-61. doi: 10.1016/j.jclinane.2004.04.003. PubMed PMID: 15721731.
- 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. doi: 10.4103/2277-9175.180635. PubMed PMID: 27169097; PubMed Central PMCID: PMCPMC4854025.
- Shahriari A, Nataj-Majd M, Khooshideh M, Salehi-Vaziri S. The comparison of post-dural puncture headache treatment with acetaminophen-caffeine capsule and intravenous mannitol infusion: A randomized single-blind clinical trial. Curr J Neurol. 2021;20:95-101. doi: 10.18502/cjn.v20i2.6745. PubMed PMID: 38011456; PubMed Central PMCID: PMCPMC8743175.
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