Post-dural puncture headache prevention and treatment with aminophylline or theophylline: a systematic review and meta-analysis

Abstract

Background: Post-dural puncture headache (PDPH) is one of the most common complications in patients undergoing spinal anesthesia. The present systematic review and meta-analysis aimed to assess the therapeutic and prophylactic effects of aminophylline and theophylline on PDPH.Methods: Relevant studies were identified by searching the following electronic databases, without language restriction, until June 2020: Scopus, EMBASE, MEDLINE, Google Scholar, Web of Science, Cochrane Library-CENTRAL, and CINAHL Complete. Random effects models were used to calculate the standardized mean difference (SMD) and risk ratios (RRs) with 95% confidence intervals (95% CI) to assess the therapeutic and prophylactic effects of aminophylline and theophylline on PDPH, respectively. The Cochrane tool was used for the quality assessment of the included studies. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation method.Results: Of the 1,349 initial records, 15 met our eligibility criteria (6 studies on therapeutic and 9 on prophylactic effects). A significant reduction in the pain score was observed following aminophylline/theophylline treatment (SMD = –1.67; 95% CI, –2.28 to –1.05; P < 0.001, I2 = 84.7%; P < 0.001). Subgroup analysis revealed that the therapeutic effect was significantly higher when these agents were compared to placebo than when conventional therapies were used. The risk of PDPH after aminophylline administration was not significantly reduced (RR = 0.74; 95% CI, 0.42 to 1.31; P = 0.290).Conclusions: Theophylline and aminophylline have therapeutic, but not prophylactic, effects on PDPH.

Ultrasound-Guided Suprazygomatic Sphenopalatine Ganglion Block for Postdural Puncture Headache Resistant to Epidural Blood Patch: A Case Report

“…In a large-scale study reported by Safa-Tisseront et al 14 in predominantly parturient patients, EBP achieved complete relief of PDPH in 75% of patients, with 18% reporting partial relief, while 7% showed no or minimal relief. This may be higher if dural puncture occurs with a larger diameter needle (ie, ≥20 gauge).In the event of resistance or recurrence of headache after EBP, a repeat blood patch often leads to the recovery of headache, with a success rate between 65% and 98% 2 but EBP remains an invasive procedure carrying the risks of complications, especially with repeated injection, such as repeat dural puncture, subdural hematoma adhesive arachnoiditis, meningitis, subdural abscess, cerebral venous sinus thrombosis, spastic paraparesis, and cauda equina syndrome. 15 In our case, the EBP failed to deliver a notable improvement in symptoms.…”

“…In addition, this may be refractory to conservative measures. 2 Epidural blood patch (EBP) is considered the definitive treatment for severe cases of PDPH resistant to conservative treatment. Its use can usually provide immediate relief of symptoms, with a success rate of 65%-98% after the first EBP.…”

Efficacy of therapies for post dural puncture headache

“…However, a recent systematic review and meta-analysis on PDPH management via aminophylline or its compound with ethylenediamine (theophylline) found both substances associated with lower pain scores. Of note, stronger effects were observed when comparing against placebo than against conventional measures [ 22 ].…”

Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review

“…Patients with PDPH typically present with frontal or occipital headaches radiating to the neck or shoulder area within six to 72 hours of the procedure. The headache gets worse in an upright position and relieves in a supine position [ 2 - 4 ]. Nausea, vomiting, dizziness, tinnitus, stiff neck, and visual abnormalities are possible associated symptoms [ 5 ].…”

“…When a pencil-point spinal needle is used, the risk of PDPH is reduced [ 2 ]. The risk of PDPH can be influenced by the size, shape, and orientation of the spinal needles, as well as the patient's posture [ 4 ].…”