Prophylactic administration of aminophylline plus dexamethasone reduces post-dural puncture headache better than using either drug alone in patients undergoing lower extremity surgery

Abstract

Background:Post-dural puncture headache (PDPH) is a known complication of neuroaxial anesthesia and may be associated with significant morbidity. As invasive treatment for PDPH has known complications, pharmacologic management may be preferable. The main objective of the present study was to evaluate the effects of combining administration of intravenous aminophylline and dexamethasone on PDPH in patients who underwent lower extremity surgery in comparison with using either drug alone and also comparing them with placebo.Materials and Methods:One hundred and forty patients, aged 20-65 years, scheduled for lower extremity surgery in Alzahra University Hospital under spinal anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. Patients were divided into four groups of 35 each and received aminophylline 1.5 mg/kg i.v. (group A), dexamethasone 0.1 mg/kg (group D), aminophylline 1.5 mg/kg plus dexamethasone 0.1 mg/kg i.v. (group AD), and placebo (group P). The incidences of PDPH and complete response were evaluated at 6-48 h after arrival to the ward in the four groups.Results:Patients in group AD had significantly lower incidence of PDPH (5.88% vs. 20.58% for group A and 17.14% for group D with P < 0.05), the highest incidence of complete response, and also, less analgesic requirement compared with groups A, D, and P throughout 6-48 h (1.2 ± 0.4 vs. 2.3 ± 0.75 for group A, 1.8 ± 0.6 for group D, and 3.3 ± 1 for placebo group with P < 0.05).Conclusion:Combine administration of aminophylline 1.5 mg/kg plus dexamethasone 0.1 mg/kg significantly reduced PDPH better than using either drug alone in patients who underwent lower extremity surgery under spinal anesthesia.

Aminophylline Versus Acetaminophen in the Treatment of Post-Dural Puncture Headache

“…They concluded that Combine administration of aminophylline 1.5 mg/kg plus dexamethasone 0.1 mg/kg significantly reduced PDPH better than using either drug alone in patients who underwent lower extremity surgery. Postoperative analgesic requirement was significantly less in groups A, D, and AD compared with group P. The results of this study did not show any significant adverse effect such as tachycardia or restlessness due to study drug administration (21) .…”

Effect of pre-administration with aminophylline on the occurrence of post-dural puncture headache in women undergoing caesarean section by combined spinal-epidural anaesthesia

“…At present, the mechanism by which aminophylline prevents PDPH remains unclear, but it may be related to the inhibition of calcium uptake by the endoplasmic reticulum of endothelial cells, stimulation of sodium and potassium pumps, increased secretion of cerebrospinal fluid, contraction of intracranial blood vessels by blocking adenosine receptors and blocking the transmission of pain perception. 20…”

Headache in patients undergoing general anesthesia

“…Подаци који су коришћени у истраживању прикупљени су из медицинске историје испитаника и у интервјуу, коришћењем анкетног упитника. Интервју је обављан 24 h након буђења пацијента из анестезије (18). Анкетни упитник је специјално дизајниран за потребе ове студије и њиме су прикупљени следећи подаци: животна доб испитаника, пол, образовање, пребивалиште, позитивна историја главобоља, породична историја главобоља, тип операције, конзумација цигарета, алкохола и унос кофеина.…”