Effect of intrathecal fentanyl for prevention of PDPH in caesarean section: A randomized control study

Abstract

Background and Aim: Subarachnoid block is the most commonly used technique for infraumbilical surgeries as it is safer, easier to perform and economical. The aim was to compare the incidence of post dural puncture headache (PDPH) with or without intrathecal fentanyl in parturients undergoing lower segment cesarean section (LSCS). Methodology: The study was conducted in Pt. JNM Medical College Raipur. 250 patients undergoing caesarean section were included after approval from the Institutional Ethical Committee. The study CTRI number is: CTRI/2022/03/0410. A written informed consent was obtained from all the patients and incidence of PDPH following spinal anaesthesia with or without intrathecal fentanyl in parturients undergoing LSCS. The patients were divided equally into two groups (F and C) using random number table. We used VAS score to assess severity of PDPH and treatment was done with bed rest, adequate hydration, coffee and tab paracetamol 500 mg. Result: The demographic profile was comparable in both the groups. The incidence of PDPH was 0.8% with fentanyl group and 4% with control group. The PDPH was mild in fentanyl group and moderate in control group. Backache, vertigo, nausea and vomiting each had an incidence of 0.8% in the fentanyl group as compared to 2.4% cases of backache, nausea and vomiting in control group. Pruritus was not reported in either of the groups. Conclusion:We concluded that the incidence and severity of post dural puncture headache (PDPH) was decreased with intrathecal fentanyl (25 µg) in caesarean section in a non-significant manner. Though the severity increased in the control group, but it was also insignificant. Although an overall protective effect of neuraxial fentanyl was not observed in this study, its role as prevention for PDPH in caesarean section remains to be investigated.