The preventive effects of oral caffeine and melatonin on headache after spinal anesthesia for lower limb surgery: A double-blinded, randomized clinical trial

Abstract

Background: Postdural puncture headache (PDPH) is a common complication after spinal anesthesia, mainly due to the loss of cerebrospinal fluid. This study was aimed to compare the preventive effect of oral caffeine (CAF) and melatonin (MEL) on headache after the spinal anesthesia for lower limb surgery (LLS).Methods: A double-blinded, randomized clinical trial enrolled on 150 patients undergoing LLS were randomly divided into three groups (n = 50 in each). CAF, MEL, and placebo (PBO) (control group) receiving a capsule containing 300 mg CAF, MEL 3 mg tablet, and a placebo 1 h before the spinal anesthesia. While recording the variables (SaO2, heart rate, mean blood pressure, and the dose of analgesic drug consumption), the pain score was measured using the visual analog scale at 12 and 24 h, as well as 2, 3, 5, and 7 days after surgery, afterward followed by SPSS-based data analysis.Results: Significant differences were found in headache pain score among the three groups (P < 0.001). The lowest pain score was seen with the CAF until 3 days after the surgery and in the MEL on day 5 and 7 days after the surgery. The incidence of PDPH in CAF, MEL, and PBO groups was 18%, 22%, and 36%, respectively (P = 0.006).Conclusion: CAF and MEL reduced the incidence of PDPH after spinal anesthesia for LLS with no hemodynamic changes. Based on the study results, the preventive effects of CAF on PDPH have been confirmed, and MEL can be suggested to be used for its prevention. However, further studies, with larger sample sizes, will be needed to completely prove these findings.