Effects of aminophylline and dexamethasone prophylaxis on headache after spinal anesthesia in cesarean section: a randomized clinical trial

Razavizadeh, Seyyed Mohammadreza; Ebnenasir, Mehdi; Sehat, Mojtaba; Pouramini, Alireza

doi:10.1016/j.bjane.2021.11.012

Cited by 2 publications

(8 citation statements)

References 3 publications

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“…Finally, 22 RCTs were included in our final analysis (Fig. 1 ) [ 18 – 21 , 25 – 42 ]. The inter-rater agreement was very good for titles/abstracts and full-text screening (κ = 0.87 and 0.93, respectively).…”

Section: Resultsmentioning

confidence: 99%

“…Twenty trials reported a difference in cumulative incidence of PDPH within 7 days among pharmacological therapies and placebo groups [ 18 – 21 , 25 , 27 – 35 , 37 – 42 ]. Of these 4,697 pregnant women, 2,611 received pharmacological therapies, and 2,086 received the placebo treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies showed that theophylline [ 58 ] and caffeine [ 59 ] might prevent PDPH by adenosine antagonization and vasoconstriction. Therefore, some doctors have tried to explore its efficacy in preventing PDPH among women experiencing Caesarean sections [ 19 – 21 , 26 , 30 , 37 ]. However, they obtained conflicting results.…”

Section: Discussionmentioning

confidence: 99%

“…However, they obtained conflicting results. Three trials found positive results [ 26 , 30 , 37 ], and the other three had negative results [ 19 – 21 ]. A meta-analysis, published in 2021, revealed that AMP could not prevent PDPH, but decreased pain scores in individuals who underwent different surgeries under spinal anesthesia and developed PDPH [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the results were inconsistent. There have been few randomized controlled trials (RCTs) that directly compared these pharmacological therapies [ 18 – 21 ]. In this study, a network meta-analysis (NMA) was therefore conducted comparing these prophylactic pharmacological therapies among pregnant women during the perinatal period.…”

Section: Introductionmentioning

confidence: 99%

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

Zhao

Song

Liu

2023

BMC Pregnancy Childbirth

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Background Post-dural puncture headache (PDPH) is a major complication of neuraxial anesthesia. PDPH usually occurs after Caesarean section in obstetric patients. The efficacy of prophylactic pharmacological therapies remains controversial. Methods Seven pharmacological therapies (aminophylline (AMP), dexamethasone, gabapentin/pregabalin (GBP/PGB), hydrocortisone, magnesium, ondansetron (OND), and propofol (PPF)), were studied in this Bayesian network meta-analysis. The primary outcome was the cumulative incidence of PDPH within 7 days. Secondary outcomes included the incidence of PDPH at 24 and 48 h postoperatively, the severity of headache in PDPH patients (24, 48, and 72 h postoperatively), and postoperative nausea and vomiting (PONV). Results Twenty-two randomized controlled trials with 4,921 pregnant women (2,723 parturients received prophylactic pharmacological therapies) were included. The analyses demonstrated that PPF, OND, and AMP were efficient in decreasing the cumulative incidence of PDPH during the follow-up period compared to the placebo group (OR = 0.19, 95% CI: 0.05 to 0.70; OR = 0.37, 95% CI: 0.16 to 0.87; OR = 0.40, 95% CI: 0.18 to 0.84, respectively). PPF and OND had the lower incidence of PONV compared to the placebo group (OR = 0.07, 95% CI: 0.01 to 0.30; and OR = 0.12, 95% CI: 0.02 to 0.63). No significant difference in other outcomes was found among different therapies. Conclusions Based on available data, PPF, OND, and AMP may have better efficacy in decreasing the incidence of PDPH compared to the placebo group. No significant side effects were revealed. Better-designed studies are requested to verify these conclusions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Zhao

Song

Liu

2023

BMC Pregnancy Childbirth

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

Alatni,

Alsamani,

Alqefari

2024

Cureus

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Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. The treatment and prevention options for PDPH differ widely from one institution to another. The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. This study aimed to summarize all articles published during the past decade that discussed the treatment or prevention of PDPH. From 2013 to 2023, 345 publications were filtered for all treatment and prevention approaches used for PDPH patients. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines were followed for conducting this systematic review, and 38 articles were included for analysis and review. Existing data come from small randomized clinical trials and retrospective or prospective cohort studies. This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results. Consequently, the use of neuraxial morphine or epidural dexamethasone for the prevention of PDPH remains questionable. Regarding the posture of the patient and its consequences on the incidence of the headache, lateral decubitus is better than a sitting position, and a prone position is better than a supine position. Smaller non-cutting needles play a role in avoiding PDPH. Minimally invasive nerve blocks, including sphenopalatine ganglion or greater occipital nerves, are satisfyingly effective. Epidural blood patches remain the more invasive but the gold standard and ultimate solution in patients resisting medical therapy. This study highlights the need for larger research to define the best approach to prevent and treat PDPH.

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Effects of aminophylline and dexamethasone prophylaxis on headache after spinal anesthesia in cesarean section: a randomized clinical trial

Cited by 2 publications

References 3 publications

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

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

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

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