Abstract
Aim: To evaluate the efficacy of oral Theophylline for the management of post dural puncture headache (PDPH). Material and Method: Forty patients with PDPH, whose surgeries were done under spinal anaesthesia, were selected randomly and divided into two groups of 20 each. One group to receive conservative treatment and the other group Theophylline (400 mg) only orally. Intensity of headache was analysed using a visual analogue scale (VAS) of pain. Assessment was done immediately before (0 h) and at 8, 16 and 24th hr of drug administration. Result: Significantly better relief of PDPH was found in Theophylline (9.3±5.7) than the conservative group (56.7 ±10.2) (p<0.001). Recurrence of headache was found in 2 patients (10 %) at 16th hr and 2 (10%) at 24th hr in the Theophylline group compared to 12 (60%) and 14 (70%) patients respectively in the other group. Conclusion: The study concludes that Theophylline in the management of post dural puncture headache may be considered the best choice over the conventional approach. DOI: http://dx.doi.org/10.3329/bjms.v13i2.18292 Bangladesh Journal of Medical Science Vol.13(2) 2014 p.114-118
Highlights
Post-dural puncture headache (PDPH) is an iatrogenic and distressing headache which, as the name implies, occurs due to puncture of the dura mater.“Toward the evening I was forced to take to bed and remained there for nine days, because all the Manifestations recurred as soon as I got up
The incidence of post dural puncture headache (PDPH) is estimated to be between 30-50% following diagnostic or therapeutic Lumbar puncture, 0-5% following spinal anesthesia and up to 81% following accidental dural puncture during epidural technique .The incidence of dural puncture ranges from 0.16%–1.3% in experienced hands[9]
Surgeries which could be done under spinal anaesthesia were timed in the afternoon so that if PDPH occurred, treatment could be started at bed time at around 10P.M., Indian Standard Time (IST). 40 patients of ASA I and II suffering from post dural puncture headache were selected for the study. 20 patients in each group were selected randomly
Summary
Post-dural puncture headache (PDPH) is an iatrogenic and distressing headache which, as the name implies, occurs due to puncture of the dura mater. “Toward the evening I was forced to take to bed and remained there for nine days, because all the Manifestations recurred as soon as I got up. At midnight a violent headache set in that quickly became insupportable.”. August Bier 1898– a personal experience of post-dural puncture headache. This was the first reported post-dural puncture headache by the German surgeon, Dr.Karl August Bier.
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