Abstract
Background: The effect of Dexamethasone on Post-Dural Puncture Headache (PDPH) after spinal anesthesia has not been well elucidated. The aim of the current study was to evaluate the effect of prophylactic intravenous dexamethasone on the incidence and severity of PDPH in patients undergoing orthopedic surgery. Methods: This randomized, double-blind, placebo-controlled trial was carried out in patients undergoing orthopedic surgery. The subjects were randomly divided into a placebo (n=140) and a dexamethasone (n=140) group. During the surgery, the control group participants were injected 2cc of distilled water, and the dexamethasone group participants were injected 2cc (8mg) of dexamethasone as an infusion in the veins. The incidences of PDPH on the first, third and seventh postoperative days were studied. Data were analyzed using SPSS version 22. Results: A total of 280 patients with a mean age of 32.7 ± 11.0 years were studied. The incidence of PDPH on the first day of post-operative period was lower in the dexamethasone group than the control group (21 vs. 34, P<0.05). This difference was disappeared on days 3 and 7. Nausea or vomiting occurred less in the dexamethasone group (9 vs. 26, P<0.05). However, no statistically significant association was found between study groups and the incidence of back pain (P>0.05). Conclusion: Although the frequency of PDPH was less in patients receiving dexamethasone, the incidence increased days after the operation and reached the level of the placebo group. We do not recommend prophylactic intravenous dexamethasone for the prevention of PDPH.
Highlights
Spinal anesthesia is one of the common methods used in Obstetrics and gynecology surgeries, urologic surgeries, orthopedic surgeries, etc
The findings of the present study indicated that Post-Dural-Puncture Headache (PDPH) is not a severe complication for spinal anesthesia, and Dexamethasone does not have a remarkable effect on the recovery of the patients’ PDPH; this is consistent with the findings of some of the previous studies [25 - 27]
In the study conducted by Motaghi et al, 2011 on the women candidate for elective caesarean section, the findings indicated that prescribing 8mg of prophylactic Dexamethasone does not have any effect on the incidence rate of the post-spinal anesthesia headache [29]
Summary
Spinal anesthesia is one of the common methods used in Obstetrics and gynecology surgeries, urologic surgeries, orthopedic surgeries, etc. Spinal anesthesia is a form of regional anesthesia involving the injection of a local anesthetic into the subarachnoid space [1] The complications of this method include neurological complications, low blood pressure, Bradycardia and Asystole, Post-Dural-Puncture. Post-Dural-Puncture Headache (PDPH) that is considered as the most important dilatory complication, was first reported in 1899 [3]. The risk factors affecting the incidence of post-spinal anesthesia headache include age, femininity, and previous headache history [2, 4]. The incidence rate of post-spinal anesthesia headache has been reported to be 11-66 percent [6]. The effect of Dexamethasone on Post-Dural Puncture Headache (PDPH) after spinal anesthesia has not been well elucidated. The aim of the current study was to evaluate the effect of prophylactic intravenous dexamethasone on the incidence and severity of PDPH in patients undergoing orthopedic surgery
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