Efficacy of Epidural Dexamethasone for Prevention of Post Dural Puncture Headache: A Randomized Controlled Trial
Keywords:Post dural Puncture headache, Epidural dexamethasone, spinal analgesia
Objective: To evaluate the efficacy of epidural dexamethasone for prevention of post dural puncture headache.
Study Design: Randomized Controlled Trial
Place and Duration: Department of anaesthesia Holy Family, hospital, Rawalpindi from January 2017 to September 2017, in a period of nine months.
Methodology: The patients were selected from general, orthopedic, urology, and gynecology services. In study group an intervention was made through a prophylactic dose of epidural dexamethasone injection in a dose of (2 ml, 8 mg) and in control group 2 ml normal saline was injected at the time of anesthesia along with standard spinal anesthesia. The anesthesia was administered between third and fourth vertebral spaces L3 and L4 in sitting position. The dose of anesthetic was standardized at 75mg Lindocaine 5% and 25mg Fentanyl, which was administered using a 25-gauge disposable needle. The incidence of a headache was the main outcome of the study and it was measured in first 24 hours, 72 hours and 7 days after spinal anesthesia.
Results: The mean age in the intervention group was 32.18 ± 5.64 years, and control group it was 31.63 ± 6.24 years. It was observed that 3 (5.56%) patients in intervention group and 7 (12.96%) patients in control group had post dural puncture headache. The rate of a headache was significantly higher in control group after 72 hours of operation. The rate of post dural puncture headache after 7 days was significantly greater (20.37% versus 38.89%, p-value < 0.05) in control group. The comparison of mean VAS scores of pain at 24 hours and 72 hours showed that mean pain score was significantly (p-value < 0.05) lower in the intervention group. There was no statistically significant (p-value > 0.05) difference in the mean value of pain score after 7 days.
Conclusions: It was observed that epidural administration of dexamethasone during spinal anesthesia is effective and useful in preventing headaches. So intravenous epidural dexamethasone is suggested for prevention of headaches in patients who undergo spinal anesthesia.