Abstract
BackgroundPost-Dural Puncture Headache is the commonest complication of spinal anesthesia. Body of evidence revealed that Conservative management failed to show significant benefit and epidural needle and catheter techniques didn’t provide conclusive evidence. On the other hand, intrathecal injection of normal saline is a simple technique and cost-effective in a resource-limited setup but it is not well examined on its effectiveness and safety profiles. Methods and materialsAfter Obtaining Ethical clearance from IRB, 152 mothers scheduled for cesarean section under spinal anesthesia were allocated randomly into two groups. Data analysis was done with SPSS version 22. Descriptive statistics were run to see the overall distribution of the study subjects. Unpaired student’s T-test for continuous symmetric data and Mann-Whitney U test for non-normally distributed data were used. Categorical data were analyzed with Chi-square and fisher’s exact test where appropriate. A generalized estimating equation model was used to investigate the interaction of repeated measurements of NRS pain scores of PDPH. ResultThe overall incidence of PDPH was 29.6% while the proportion of patients who experienced PDPH was the highest among patients with control as compared to intervention( 36.8% vs 22%) respectively. The GEE model revealed that the NRS pain score was 0.7, 0.4, and 0.2 unit higher at 12, 24, and 48 respectively in control as compared to the intervention Conclusionprophylactic intrathecal normal saline could be an option in a resource-limited setup where the appropriate spinal needle is not accessible and management of moderate and severe PDPH is not feasible RegistrationThe protocol was registered prospectively in Clinical Trials.gov (NCT04393766).
Highlights
The global rate of cesarean section is increasing despite the World Health organization's recommendation rate of cesarean section[1, 2]
Conclusion: prophylactic intrathecal normal saline could be an option in a resource-limited setup where the appropriate spinal needle is not accessible and management of moderate and severe PDPH is not feasible
80–90% of cesarean sections are performed with spinal anesthesia which is relatively safe as compared to general anesthesia which is accompanied by a difficult airway and risk of aspiration[3,4,5,6]
Summary
The global rate of cesarean section is increasing despite the World Health organization's recommendation rate of cesarean section[1, 2]. The International Headache Society (IHS) defines PDPH as ‘‘Headache occurring within 5 days of a lumbar puncture caused by cerebrospinal fluid (CSF) leakage through the dural puncture. It worsens 15 minutes of standing or sitting and improves after 15 minutes of lying down. It is usually accompanied by neck stiffness and/or subjective hearing symptoms, nausea and vomiting, photophobia. It recovers spontaneously within one week, or after sealing of the leak with an autologous epidural lumbar patch within 48 hrs. Intrathecal injection of normal saline is a simple technique and cost-effective in a resource-limited setup but it is not well examined on its effectiveness and safety profiles
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