Tehran University Medical Journal

Background: The post-dural puncture headache (PDPH) is a common complication in spinal anesthesia. Headache may occure seven days after dural puncture. The headache may be worsened in sitting position and be better in supine position. PDPH is common in younger and tall people. The incidence rate of PDPH related to the size of spinal needle and the number of try and decrease with small, cutting needle and less puncture try. PDPH is a well-known iatrogenic complication of spinal anesthesia, which continues to be a major problem. In this study, we assessed the effect of intravenous aminophylline on prevention of post-spinal anesthesia headache in who were elective for cesarean sections.
Methods: This double-blind randomized clinical trial was conducted on 140 women with 18 to 35 years old and American Society of Anesthesiologists Classification (ASA Class) I and II undergoing spinal anesthesia in elective cesarean section. Patients were randomly divided into two groups called case and control. After umbilical cord clamping 1 mg/kg aminophylline dissolved in 100 cc normal saline was infused to the case group but only 100 cc normal saline was infused for the control group. Patient's blood pressure and heart rate were recorded before spinal anesthesia, immediately after spinal anesthesia, after uterine incision and umbilical cord clamping, after drug injection and then every five minutes. The incidence of headache was assessed at 4, 8, 24, 48 and 72 hours after the surgery.
Results: Although severity and duration of headache in case group was more than in control group, no meaningful difference was found between two groups. The mean changes in systolic blood pressure were greater in control group (P<0.001). The mean changes in heart rate was greater in case group than control group (P<0.001).
Conclusion: This study showed that intravenous aminophylline although, caused hemodynamic changes in some case, but it doesn't have any effect on prevention of incidence and severity of post-spinal anesthesia headache in elective cesarean section.

Background: Post-dural puncture headache (PDPH) is commonly seen after neuraxial block and it usually lasts for up to two days or in some cases for up to two weeks. Several types of regimens have been suggested for treatment, such as theophylline and caffeine. This study aimed to evaluate the effects of aminophylline, paracetamol, and administration of aminophylline and paracetamol concurrently on prevention of PDPH.
Methods: In a double-blind randomized clinical trial, we evaluated 120 patients in four groups (n=30) undergoing spinal anesthesia for extremity surgery in educational hospitals of Isfahan University of Medical Sciences (Alzahra and Ayatollah Kashani Hospitals), Iran, from 2016 to 2017. In group A aminophylline was injected slowly intravenously (1.5 mg/kg), in group B paracetamol (1000 mg) was injected intravenously, in group C aminophylline and paracetamol was injected with the same dose and in control group (n=30) normal saline was injected intravenously. After patients entered the operating room, mean arterial blood pressure and heart rate were measured and oxygen saturation was monitored. Before spinal anesthesia, 15 minutes before leaving the recovery room, every 6 hours in first day and daily in first week after the surgery, incidence of PDPH in each group were evaluated. The frequency of nausea between the four groups was also studied.
Results: 42 patients (35%) out of the 120 ones suffered from headache. 40% of patients who had received aminophylline, 33.3% of patients who had received paracetamol, 20% of patients who had received aminophylline and paracetamol and 46.6% of patients who had not received any drug suffered from headache (P=0.05). The frequency of nausea was not significantly different between the four groups at any time. The average of heart rate, mean arterial pressure and oxygen saturation in recovery and 24 hours after operation were not significantly different between the four groups.
Conclusion: This study shows that intravenous administration of aminophylline and paracetamol significantly reduces the incidence of post-dural puncture headache (PDHP) in lower extremity surgery and we can use this regimen for prevention.