Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial

Abstract

Background and Aims: Postdural puncture headache (PDPH) is a side effect of spinal anaesthesia (SA). This study was conducted to investigate the effect of intrathecal fentanyl on the incidence, severity, and duration of PDPH. Methods: This was a prospective randomised controlled study including 220 parturients, who underwent Caesarean section (CS). They were divided into two groups for administration of SA with bupivacaine (bupivacaine group [B0], n = 111) or bupivacaine with fentanyl (bupivacaine fentanyl group [BF], n = 109). Haemodynamics, quality of anaesthesia, maternal side effects, and postoperative analgesia were noted. The neonatal Apgar score was recorded. The patients were followed up for 14 days after CS for the occurrence of PDPH, and its severity and duration. The collected data were statistically analysed, using the Statistical Package for the Social Sciences software version 25. Results: Regarding haemodynamics, heart rate increased at 5 min post-induction and blood pressure decreased at 2min post-induction in both groups. Excellent intraoperative anaesthesia was obtained in 91.7% and 79.3% of cases in groups BF and B0, respectively ( P < 0.01). Longer duration of postoperative analgesia was present in the BF group as compared to the B0 group ( P < 0.001). The incidence of PDPH decreased in the BF group in a non-significant manner, whereas its severity and duration increased significantly in the B0 group. Conclusion: Although the addition of intrathecal fentanyl to bupivacaine for SA in CS patients did not reduce the incidence of PDPH significantly, its severity and duration decreased significantly.

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

“…The incidence of PDPH in our study was less in fentanyl group as compared to control group which was statistically insignificant (graph 1). Similar results has been reported previously where addition of opioids to local anesthetic have decreased the severity and duration of PDPH but has not reduced the incidence of PDPH [5,6] . The mechanism is not known but it has been suggested that it could be due to systemic absorption of intrathecal morphine.…”

“…Severity of headache and Visual Analogue Scale score for pain intensity of PDPH was mild in fentanyl group as compared to control group (Table 2). The severity of PDPH differs significantly in control group as compared to opioid group as indicated by higher VAS score [6,8,10,12] . The difference in the incidence of backache, nausea, vomiting, vertigo, pruritis was not statistically significant between the groups and no other symptom was observed in either group (graph 2).…”

“…The overall incidence varies between 0 to 37.2% [5] . The mechanism is believed to be a decrease in CSF pressure due to which there is sagging of the contents of the skull hence it is also called low pressure headache [6] . PDPH can be prevented by using finer spinal needle, alignment of needle parallel to dura fibers, maintaining adequate hydration, providing analgesics and caffeine [5] .…”

Caesarean Delivery: A Narrative Review on the Choice of Neuraxially Administered Opioid and Its Implications for the Multimodal Peripartum Pain Concept

“…Although intrathecal opioids are used daily worldwide in combination with local anesthetics, there is no clear study situation as to which opioid is ideal for caesarean delivery. In the last 25 years, five systematic reviews have dealt with this question in the broadest sense, as well as several randomized controlled trials [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. The first systematic review found that, in a relatively small total number of patients, intrathecal fentanyl and sufentanil have no advantage over the administration of local anesthetics alone.…”

Improving the perioperative compliance and quality care in obstetric and paediatric anaesthesia: Challenges and anodynes

“…Nevertheless, Ali et al . [ 12 ] and Prakash et al . [ 13 ] attempted to shed some light on PDPH through their studies in the present issue of IJA.…”