Nebulized dexmedetomidine versus neostigmine/atropine for treating post-dural puncture headache after cesarean section: a double-blind randomized controlled trial.

Abstract

Post-dural puncture headache (PDPH) is one of the most common complications of neuraxial anesthesia after an accidental dural puncture. This study aimed to test non-interventional alternatives to treat PDPH. Our goals were to compare the effectiveness of nebulized dexmedetomidine (DEX) versus neostigmine/atropine in the conservative management of PDPH. A randomized double-blind controlled study of ninety (90) women divided into three equal groups: group C (given nebulization of saline 0.9% placebo in four mL), group N (given nebulization of 20 µ/kg neostigmine and 10 µ/kg atropine diluted in four mL normal saline), and group D (given nebulization of dexmedetomidine 1 µg/kg diluted in four mL normal saline). Nebulization was done twice daily for three days, and a Visual Analogue Scale pain score (VAS) was recorded for seventy-two hours after the intervention for the three groups with a VAS Score equal or less than three being the cutoff value. VAS was significantly decreased in dexmedetomidine, and neostigmine/atropine groups compared to the control group at six hours (median VAS: 5, 2, and 2 for groups C, N, and D respectively [P=0.001]). There was a significant difference in VAS trends between the three groups (at six, twelve, twenty-four, thirty-six, and forty-eight hours [P=0.001], and at seventy-two hours [P=0.003]). No patients in group D, but one patient in group N and seven patients in group C needed an epidural blood patch. Nebulized dexmedetomidine and neostigmine/atropine had a rapid effect on relieving PDPH after cesarean section.