The Rate and Severity of Headache after Caesarean Section under Spinal Anaesthesia are decreased by Hypertonic Solutions: A Randomized Placebo-Controlled Clinical Trial

Abstract

Aim: To determine the frequency and severity of post-dural puncture headache (PDPH) in women undergoing spinal anaesthesia for caesarean section who received an infusion of Voluven or Ringer before the procedure. Methods: We enrolled 240 full term women scheduled for elective caesarean section in this study. Participants were randomly allocated equally to Ringer (A) and Voluven (B) groups. After arrival in the operating room 500 ml of ringer solution was infused within 10-15 min before spinal block in the Ringer group, but in the Voluven group 500 ml of 6% Hydroxyethyl starch solution was infused to the patients. The frequency and severity of headache were compared between two groups. Results: The frequency of PDPH was higher in patients in Ringer group compared to Voluven group at first day (P=0.01), but there were no significant differences between two groups in second (p=0.23) and third days (p=0.30). The severity of headache in Ringer group was significantly more than patients in Voluven group in every three days significantly. Hypotension occurred in 95 patients in Ringer Group (79.17%) and in 76 patients in Voluven Group (%63.33) (P=0.007). The frequency of nausea and vomiting was seen in 27 patients in Ringer group (22.5%) vs. in 18 patients in Voluven group (15%) (p=0.10). Conclusion: Hydration with hypertonic solutions (Voluven) before caesarean section under spinal anaesthesia can decrease the rate and severity of PDPH compared with hydration with Ringer solution.