Comparative study between hydrocortisone and mannitol in treatment of postdural puncture headache: A randomized double-blind study

Abstract

Background: Postdural puncture headache (PDPH) is a common complication after lumbar puncture. Anesthesiologists are the most likely to be consulted for the treatment. PDPH may be debilitating for a patient and can interfere with daily activities and quality of life. Methods: Fifty patients of both sexes, aged 18-50 years and ASA I and II undergoing elective lower abdominal and pelvic surgery under spinal anesthesia were included in this randomized double-blind study. Patients were randomly divided into 2 groups 25 each: hydrocortisone group received intravenous hydrocortisone 100 mg every 8 h for 48 h and mannitol group received intravenous infusion of mannitol 20% 100 ml over 30 min followed by 100 ml every 12hours. Mean (±SD) of headache intensity at 0, 6, 12, 24 and 48 h after beginning of treatment was assessed using visual analogue scale. Results: There was no significant difference regarding headache intensity between two groups before beginning of treatment. The VAS was significantly reduced in hydrocortisone group than in mannitol group at 6, 12, 24 h with P-value 0.030, 0.007, 0.004 respectively. At 48 h, both groups had nearly the same VAS of headache intensity, with P-value 0.305. Conclusion: Both intravenous hydrocortisone and mannitol intravenous infusion were efficient in reducing postdural puncture headache within 48 h. Hydrocortisone showed earlier and significant relief of headache.

The comparison of post-dural puncture headache treatment with acetaminophen-caffeine capsule and intravenous mannitol infusion: A randomized single-blind clinical trial

“…Our results are consistent with the study of Kassim and Esmat. 23 They found that IV infusion of mannitol 20% 100 ml over 30 minutes followed by 100 ml every 12 hours reduced greatly the intensity of headache after spinal anesthesia. In their study, 90% of patients in the mannitol group showed recovery from headache at 48 hours.…”

“…In their study, 90% of patients in the mannitol group showed recovery from headache at 48 hours. 23 Rizvi et al used mannitol infusions to treat PDPH successfully for years. 22…”

“…A few studies investigated the efficacy of mannitol infusion for the management of PDPH. 22 , 23 Rizvi et al used mannitol infusion to treat PDPH and obtained positive achievements. 21 Mannitol increases the blood osmolality and decreases the brain liquid volume, so the brain bulk and intracranial pressure (ICP) will decrease.…”

“…They declared that the IV infusion of mannitol is more effective in reducing the severity of PDPH within 48 hours. 23 …”

“…No studies reported using mannitol for management of PDPH except for the study of Rizvi et al 22 and Kassim and Esmat; 23 thus, a unique protocol for treatment of PDPH was not determined, and the rate of patients that can benefit from this method was not anticipated. Therefore, the present study was planned to compare the efficacy of IV mannitol with a traditional method, oral acetaminophen-caffeine, for treatment of PDPH.…”