A double-blind placebo controlled trial on effectiveness of prophylactic dexamethasone for preventing post- dural puncture headache after spinal anesthesia for cesarean section.

Abstract

AIM:

To determine the effect of dexamethasone in reducing post-dural puncture headache (PDPH) after spinal anesthesia for cesarean section (CS).

METHODS:

A double blind placebo controlled randomized trial of parturients undergoing CS under spinal anesthesia was conducted. Participants (n = 192) were randomly (1:1 ratio) given either 2mls (8 mg) of dexamethasone (n = 96) intravenously or 2mls of normal saline (n = 96) intravenously as placebo after clamping the umbilical cord. Visual analogue scale was used to assess the incidence and severity of PDPH on the first and fourth post-operative days. The primary outcome measure was incidence of PDPH while the secondary outcome measure was incidence of nausea and vomiting. Analysis was by intention-to-treat.

RESULTS:

Baseline socio-demographic and clinical variables were similar between the two groups and none of the women was lost to follow up. The incidence of PDPH (8.3% vs 25.0%; p = .002) and nausea (11.5% vs 25.0%; p = .015) were significantly lower in dexamethasone group. The severity of headache in the control groups were statistically higher on the first (p < .001) and fourth (p < .001) post-operative days.

CONCLUSION:

Prophylactic dexamethasone reduces the incidence and severity of PDPH on both the first and fourth post-operative day after spinal anesthesia for CS. There was also an improvement on the incidence of nausea on the dexamethasone group compared to control.

• Authors: Boniface Chukwuneme Okpala, George Uchenna Eleje, Joseph Ifeanyichukwu Ikechebelu, Chukwuemeka Jude Ofojebe, Toochukwu Benjamin Ejikeme, Cyril Emeka Nwachukwu, Augusta Nkiruka Okpala
• Journal: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians (J Matern Fetal Neonatal Med) Vol. 35 Issue 17 Pg. 3407-3412 (Sep 2022) ISSN: 1476-4954 [Electronic] England
• PMID: 32928014 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Dexamethasone

Topics

• Anesthesia, Spinal (adverse effects)
• Cesarean Section (adverse effects)
• Dexamethasone (therapeutic use)
• Double-Blind Method
• Female
• Humans
• Nausea
• Post-Dural Puncture Headache (epidemiology, etiology, prevention & control)
• Pregnancy
• Spinal Puncture (adverse effects)