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

Abstract

Background: Post-dural puncture headache (PDPH) is a common problem after spinal anesthesia. Depending on the severity of PDPH, there are both invasive and non-invasive treatments. Caffeine has been used for the treatment of PDPH since 1949, but the administration of mannitol is a novel management to tackle PDPH. This study was conducted to compare the effectiveness of acetaminophen-caffeine and mannitol in the treatment of PDPH.
 Methods: We enrolled 80 patients with PDPH in the present clinical trial and observed them during 72 hours after cesarean section. Participants were randomly and equally allocated to two groups for treatment with intravenous (IV) mannitol or oral acetaminophen caffeine. The effects of treatment were evaluated using the visual analogue scale (VAS) questionnaire at hours of 1, 2, 3, 4, 6, 12, 18, 24, and 48. SPSS software was used.
 Results: Forty patients in each group completed the study. There was a significant reduction in the pain scores of the both groups after treatment, but the interaction between time and group demonstrated that mannitol administration was superior to acetaminophen-caffeine in pain reduction of the patients undergoing spinal anesthesia (P = 0.028). Patients’ satisfaction in the mannitol group was significantly higher than the caffeine group (P = 0.001).
 Conclusion: This study suggests that IV mannitol infusion affects faster and earlier for the treatment of PDPH than acetaminophen-caffeine capsule. Mannitol could be probably more effective for treatment of PDPH.

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

“…Mannitol intravenously was shown to be more effective in treating PDPH than acetaminophen-caffeine capsules when these two methods were compared in a randomized clinical trial published in 2021 [ 21 ]. In another trial, intravenous mannitol was compared to intravenous hydrocortisone, which concluded that both medications are equally effective in pain relief; however, hydrocortisone had earlier onset [ 9 ].…”

“…This systematic review identified 16 publications assessing medical drugs for the treatment and prevention of PDPH [9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. According to a retrospective assessment of medical records that included 285 patients and was published in 2013, analgesics and antiemetics, along with bed rest and IV fluids, were sufficient to manage the symptoms of PDPH in about 79% of patients [11].…”

Management of Post-Dural Puncture Headaches in Pediatric Patients with Epidural Blood or Saline Patch: An Educational Focused Review

“…Additionally, it stimulates the sodium-potassium pump and increases CSF production. 12 Both oral and IV caffeine sodium benzoate formulations may result in a transient reduction in pain scores. Oral caffeine is well absorbed, more convenient, and less expensive.…”

Non-Interventional Treatment of Post-Dural-Puncture Headache; High-Flow Oxygen and Pro-Serotonin Agents a Safe and Effective Alternative

“…Caffeine is a central nervous stimulant of the methylxanthine class and is used worldwide to enhance concentration and memory [25], with first report of usage as a treatment for PDPH in 1949 [26]. Caffeine is hypothesized to treat PDPH by inducing cerebral vasoconstriction as an adenosine receptor antagonist [27,28] since adenosine receptor activation can produce downstream vasodilatory effects via its G proteincoupled receptor activity [29].…”