Comparison of Effect of Prophylactic Aminophylline, Dexamethasone and Placebo in Prevention of Post Dural Puncture Headache

Abstract

Objective: To compare the preventive effect of prophylactic aminophylline, dexamethasone and placebo in the prevention for postdural puncture headache in adult patients undergoing below umbilicus surgery.

Material and Methods: This randomized clinical trial was done at department of anesthesia and Critical care at PIMS hospital, Islamabad from January 2018 to June 2018. Adult cases of 18 -45 years of both genders undergoing below umbilicus surgery were included. All the patients were divided in 3 groups. Group A (Aminophylline) patients received 1.5 mg/kg of IV Aminophylline over 10 minutes, group B (Dexamethasone) patients received 0.1 mg/kg of IV Dexamethasone whereas group C (Placebo) patients received IV saline, 15 minutes before the end of the surgery. The frequency of post dural puncture headache along with complications of therapy was noted at 24 hours and 48 hours of surgery and compared in all three groups. Chi-square test was employed to compare the occurrence of PDPH in all three groups and P-value ≤0.05 was considered as significant.

Results: At 24 hours headache was present in 2% of patients in group A, 2% in group D and 10.8% of patients in group P. The frequency of headache was similar in group A and D, but was significantly lesser than placebo group (P = 0.003) at 2 hours.  At 48 hours no patient in group A reported headache while headache was present in 7.8% (n=8) of patients in group B and 12.7% (n=13) of patients in group C. The frequency of headache was significantly lesser in group A as compared to group B and C (P = 0.001).

Conclusions: Post-dural puncture headache observed to the significantly lesser in patients treated with Aminophylline and Dexamethasone compared to placebo group at 24 hours, while headache was significantly lesser in patients treated with Aminophylline as compared to Dexamethasone and Placebo group.