No abstract

The study aims to evaluate the efficacy of ondansetron in preventing post-spinal headache, considering the high prevalence of the headache in pregnant women and the common use of the adjuvants for prophylaxis against post-operative nausea and vomiting (PONV). This double-blind clinical trial included the 195 patients who were referred to Taleghani Hospital (in Arak, Iran) for cesarean section (C/S) under spinal anesthesia, and then the subjects were assigned to three equally sized groups using block randomization. Participants in the first, second, and control groups received 8 mg, 4 mg of ondansetron, and normal saline, respectively, 5 minutes before surgery. A final volume of 5 cc was prepared by adding normal saline. Participants were examined for headache one week after surgery, and then data analysis was performed using SPSS 20. The incidence of post-spinal headache was significantly higher in the placebo group than in the ondansetron 8-mg and 4-mg groups at 24 hours after surgery (P < 0.010). But, no significant difference was observed between two ondansetron groups (P ≤ 0.05). The overall incidence of the headache was generally lower in ondansetron 8-mg (26.66% vs. 33.68.05%) and 31.66% in ondansetron 4-mg (P < 0.001). Moreover, the PONV incidence was significantly higher in the placebo group than in the other two groups at 24 hours (P < 0.001). The hemodynamic variables were same in three groups. The ondansetron 8-mg dose can be effective to prevent headache after spinal anesthesia for C/S. Moreover, the ondansetron 8-mg and ondansetron 4-mg have same effect in control of PONV after spinal anesthesia for C/S.

Curettage is one of the most common operations among women. Several methods are used to reduce post-operation pain. The present research seeks to study the effect of adding morphine and tramadol to lidocaine in para cervical block on post-operation analgesia. This is a double-blind clinical trial conducted on 120 women applying for curettage. The participants were divided into three completely random groups. The fi rst group received 5cc lidocaine 1.5% along with 1 mg (1cc) morphine (totally 6cc), the second group received lidocaine 1.5% and 2 mg (1cc) tramadol, and the third group received 5cc lidocaine with 1cc distilled water as placebo for para cervical block. The length and intensity of pain was registered based upon VAS table and time for requesting painkiller after operation for all three groups. The pain score in the 0th, 30th, and 60th minute in those groups receiving morphine and tramadol was less than what was observed in the group who had received lidocaine (P < 0.05), but the pain score in all times in the group who had received tramadol was signifi cantly less than other groups (P<0.05). The fi rst painkiller in morphine and tramadol groups was asked much later than lidocaine group (P < 0.05) but no signifi cant difference was observed between the morphine and tramadol groups. The side effects were similar in all groups with lower levels of Bradycardia observed in placebo group (P < 0.05). Morphine and tramadol were more effective than lidocaine creating para cervical block and analgesia and reduction of pain following the operation but tramadol exhibited a lower pain score throughout the research. The average length of analgesia in placebo group was less than what was observed in other two groups. However, no signifi cant difference was observed between tramadol and morphine groups in terms of the length of analgesia after operation.

Spinal anaesthesia (SA) is a common method during surgery due to easy administration, rapid effects, relaxes muscles and controls pain. But, post-dural puncture headache (PDPH) is a common problem after SA that occurs in 6%–36% of SA. We assessed the effect of four common treatment drugs sumatriptan, theophylline, pregabalin and oral caffeine on prevention of PDPH. In this systematic review, all randomized clinical trials (RCTs) during January 2015 and December 2021 were searched from PubMed, Google Scholar, Web of Science, Cochrane review and Clinical Key with a specific search strategy. The article qualities were assessed by two independent authors and were screened for relevant sources based on inclusion and exclusion criteria. Moreover, the included articles data were extracted and checked for regular basis. A total of 421 articles were identified and 193 articles were removed following a preliminary review and finally, 14 articles were included in review. Overall, we identified five RCTs on the effect of caffeine, two RCTs on the effect of sumatriptan, three RCTs on theophylline, three RCTs on pregabalin and one RCT on theophylline and sumatriptan in PDPH prevention. This review supports the effects of theophylline, pregabalin and sumatriptan in the prevention of PDPH incidence and treatment of PDPH intensity, but we cannot draw the same conclusions about caffeine due to some negative results about the caffeine effect. Nevertheless, this extracted conclusion should be considered and interpreted with caution and limited generalizations due to the small number of studies, the variety of evaluated drugs and measures, the low sample size and the bias presented.