Does preoperative gabapentin affects the characteristics of post-dural puncture headache in parturients undergoing cesarean section with spinal anesthesia?

Abstract

Background:Gabapentin is effective for treating different types of headache including post-dural puncture headache (PDPH), also used for prophylaxis against migraine. We studied the effect of pre-operative administration of gabapentin on the characteristics of PDPH in parturients undergoing cesarean section (CS) under spinal anesthesia.Materials and Methods:Women undergoing elective cesarean section under spinal anesthesia were randomized to receive preoperative gabapentin 600 mg or placebo. Spinal anesthesia was achieved with 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl. Babies were followed up by Apgar scores, umbilical artery blood gases, breastfeeding difficulties, and need for NICU admission. The mothers were followed up for any side-effects of gabapentin for 24 h. Patients with PDPH were re-admitted and onset and duration of the headache were reported and severity was assessed using a visual analog scale (VAS) for 4 days from diagnosis. Paracetamol with caffeine and diclofenac were given for treatment, and the doses were adjusted according to VAS; also number of doses given for each group was recorded.Results:Eighty eight patients were randomized, and 2 were excluded. The incidence of headache and co-existing symptoms were similar in both groups. The onset of headache was significantly delayed in gabapentin group (P < 0.05). Also, severity and duration of headache were significantly less in gabapentin group (P < 0.05). The incidence of sedation was more in gabapentin group 11 (26.19%) versus placebo group 3 (6.81%). Neonatal outcomes were statistically insignificant between both groups.Conclusion:Pre-operative administration of gabapentin has no effect on incidence of (PDPH) but delays its onset and reduces its severity and duration in parturients undergoing cesarean section with spinal anesthesia without significant adverse effects on the mother or the baby.

Efficacy of pharmacological therapies for preventing post-dural puncture headaches in obstetric patients: a Bayesian network meta-analysis of randomized controlled trials

“…3 , Supplemental Table S 8 ). Sedation [ 28 ], diplopia [ 33 ], and tinnitus [ 33 ] were also mentioned in individual studies, but were not involved in the qualitative synthesis. Dexamethasone did not show any superiority to other pharmacological therapies or to placebo in any secondary outcomes.…”

“…Only a few trials have focused on the efficacy of GBP [ 28 ], PGB [ 34 , 40 ], and Mg [ 41 ]. All these therapies need more raw data to draw solid conclusions.…”

Evaluation of the Effects of Oral Magnesium Sachet on the Prevention of Spinal Anesthesia-Induced Headache After Cesarean Section: A Randomized Clinical Trial

“…Using the data of Nofal et al (27), α probability 0.05, power of 80%, total sample size of 98 was calculated (49 patients per group) and finally 118 patients were studied for compensation of dropouts.…”

Unveiling the relative efficacy, safety and tolerability of prophylactic medications for migraine: pairwise and network-meta analysis

“…Placebo 58 27 6m 35.3 ③④⑨ Sarchielli et al, 2014 [ 44 ] Multi RCT Double Anticonvulsants Valproate vs. Placebo 88 21 6m 42.0 ④⑤⑦⑧⑨ Nofal et al, 2014 [ 43 ] Moni RCT Double Anticonvulsants Gabapentin vs. Placebo 86 0 4d 30.9 ⑤⑦ Outcomes: ① monthly migraine headache days; ② headache frequency; ③ ≥50% reduction in migraine headache attacks; ④ all-adverse events; ⑤ nausea; ⑥ somnolence; ⑦ dizziness; ⑧ withdrawal; ⑨ withdrawal due to adverse events …”