Effect of dexamethasone on the frequency of postdural puncture headache after spinal anesthesia for cesarean section: a double-blind randomized clinical trial

Abstract

In this study, we evaluated the effect of dexamethasone used as a prophylaxis for nausea and vomiting on the incidence of postdural puncture headache (PDPH) in pregnant women receiving spinal anesthesia for cesarean section. In a prospective, randomized, double-blind, placebo-controlled study, 372 women under spinal anesthesia received 8 mg of dexamethasone or placebo intravenously just after the umbilical cord was clamped. The rate of PDPH and correlated risk factors were evaluated. The prevalence of nausea and vomiting in the dexamethasone and placebo groups was 54.4 and 51.7%, respectively. There was no statistically meaningful difference between the results (P value = 0.673). The overall incidence rate of PDPH was 10.8%, with 28 cases from the dexamethasone group compared with 11 subjects from the placebo group (P value = 0.006). This effect was most prominent on the first day (P value = 0.046) and disappeared on the second day after spinal anesthesia (P value = 0.678). Prophylactic treatment with 8 mg of dexamethasone not only increases the severity and incidence of PDPH, but is also ineffective in decreasing the prevalence of intra-operative nausea and vomiting during cesarean section. The treatment is a significant risk factor for the development of PDPH.

Comparing the prophylactic effect of ondansetron and dexamethasone in controlling headaches caused by spinal anesthesia among women candidated for caesarean A randomized controlled trial

“…The frequency rate of this headache in dexamethasone group was 10.8%, while this frequency in placebo group was 6.2% indicating a statistically significant difference. They finally arrived at the conclusion that using this medicine is a risk factor in occurrence of headaches after dura rupture (9). These results were not in line with those achieved in our study.…”

“…These results were not in line with those achieved in our study. Dexamethasone has caused a noticeable reduction in headache scale following spinal anesthesia in our research, but Yousefshahi's results were completely different and had introduced dexamethasone as a risk factor for headaches caused by spinal anesthesia (9). The cause of difference is not clear, but the main point is that nearly all previous studies had confirmed the effectiveness of dexamethasone in reducing the headaches caused by spinal anesthesia.…”

“…This type of headache is not cured using usual painkillers (2,7,8). This makes the period of hospitalization longer and results in further physical and mental problems for mother (4,9). Ondansetron is usually used to control nausea and vomiting.…”

Postdural puncture headache: evidence-based review for primary care

“…45 Yousefshashi et al also found a reduced incidence of PDPH with dexamethasone at 24 hours (p = 0.046) but this effect was lost by the second day. 46 Intravenous hydrocortisone 200 mg stat, followed by 100 mg three times daily for 48 hours was shown to be effective in reducing the severity of PDPH among a sample of obstetric patients. 47 Similar effectiveness of hydrocortisone was also demonstrated by Alam and colleagues among non-obstetric patients.…”

Postdural puncture headache: prevention

“…Однак iншi автори з Iрану [6], якi вводили 8 мг дексаметазону внутрiшньовенно перед спiнальною анестезiєю для ортопедичних операцiй на нижнiх кiнцiвках, не виявили статистично значного зниження частоти головного болю, хоча його iнтенсивнiсть була нижчою пiсля дексаметазону. Навпаки, ще одна група дослiдникiв [19] з Тегерана (Iран) при внутрiшньовенному введеннi 8 мг дексаметазону одразу ж пiсля перетискання пуповини при кесаревiм розтинi пiд спiналь-ною анестезiєю не виявила зниження частоти пiсляоперайної нудоти та блювання, але виявила збiльшення частоти й iнтенсивностi головного болю.…”