Prophylactic administration of aminophylline plus dexamethasone reduces post-dural puncture headache better than using either drug alone in patients undergoing lower extremity surgery

Authors
Khosrou Naghibi 1
Marzieh Hamidi 2
1 Department of Anesthesia, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Anesthesiology and Intensive Care, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Post-dural puncture headache (PDPH) is a known complication of neuroaxial anesthesia and may be associated with significant morbidity. As invasive treatment for PDPH has known complications, pharmacologic management may be preferable. The main objective of the present study was to evaluate the effects of combining administration of intravenous aminophylline and dexamethasone on PDPH in patients who underwent lower extremity surgery in comparison with using either drug alone and also comparing them with placebo.
Materials and Methods: One hundred and forty patients, aged 20-65 years, scheduled for lower extremity surgery in Alzahra University Hospital under spinal anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. Patients were divided into four groups of 35 each and received aminophylline 1.5 mg/kg i.v. (group A), dexamethasone 0.1 mg/kg (group D), aminophylline 1.5 mg/kg plus dexamethasone 0.1 mg/kg i.v. (group AD), and placebo (group P). The incidences of PDPH and complete response were evaluated at 6-48 h after arrival to the ward in the four groups.
Results: Patients in group AD had significantly lower incidence of PDPH (5.88% vs. 20.58% for group A and 17.14% for group D with P < 0.05), the highest incidence of complete response, and also, less analgesic requirement compared with groups A, D, and P throughout 6-48 h (1.2 ± 0.4 vs. 2.3 ± 0.75 for group A, 1.8 ± 0.6 for group D, and 3.3 ± 1 for placebo group with P < 0.05).
Conclusion: Combine administration of aminophylline 1.5 mg/kg plus dexamethasone 0.1 mg/kg significantly reduced PDPH better than using either drug alone in patients who underwent lower extremity surgery under spinal anesthesia.

Keywords

1. Bradbury CL, Singh SI, Badder SR, Wakely LJ, Jones PM. Prevention of post-dural puncture headache in parturients: A systematic review and meta-analysis. Acta Anaesthesiol Scand 2012;28:111-20.   Back to cited text no. 1
    
2. Kara I, Ciftci I, Apiliogullari S, Arun O, Duman A, Celik JB. Management of postdural puncture headache with epidural saline patch in a 10-year-old child after inguinal hernia repair: A case report. J Pediatr Surg 2012;47:e55-7.   Back to cited text no. 2
[PUBMED]    
3. Kokki M, Sjövall S, Kokki H. Epidural blood patches are effective for postdural puncture headache in pediatrics - A 10-year experience. Paediatr Anaesth 2012;22:1205-10.   Back to cited text no. 3
    
4. Kuczkowski KM. The management of accidental dural puncture in pregnant women: What does an obstetrician need to know? Arch Gynecol Obstet 2007;275:125-31.   Back to cited text no. 4
[PUBMED]    
5. Nepomuceno R, Herd A. Bilateral subdural hematoma after inadvertent dural puncture during epidural analgesia. J Emerg Med 2013;44:e227-30.   Back to cited text no. 5
[PUBMED]    
6. Stendell L, Fomsgaard JS, Olsen KS. There is room for improvement in the prevention and treatment of headache after lumbar puncture. Dan Med J 2012;59:44-83.  Back to cited text no. 6
    
7. Kleine-Brüggeney M, Kranke P, Stamer UM. Prophylaxis and therapy of postdural puncture headache - A critical evaluation of treatment options. Anasthesiol Intensivmed Notfallmed Schmerzther 2011;46:516-24.   Back to cited text no. 7
    
8. Amorim JA, Gomes de Barros MV, Valença MM. Post-dural (post-lumbar) puncture headache: Risk factors and clinical features. Cephalalgia 2012;32:916-23.  Back to cited text no. 8
    
9. Basurto Ona X, Martínez García L, Solà I, Bonfill Cosp X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev 2011;10:78-87.  Back to cited text no. 9
    
10. Kuczkowski KM. Post-dural puncture headache in obstetric patient: An old problem. New solutions. Minerva Anestesiol 2004;70:823-30.  Back to cited text no. 10
[PUBMED]    
11. Imarengiaye C, Ekwere I. Postdural puncture headache: A cross-sectional study of incidence and severity in a new obstetric anaesthesia unit. Afr J Med Med Sci 2006;35:47-51.  Back to cited text no. 11
[PUBMED]    
12. Pranjal S, Sajan T. Post-lumbar puncture headache. Hosp Physician 2007; 43:51-4.  Back to cited text no. 12
    
13. Zajac K, Zajac M, Hl/adki W, Jach R. Is there any point in pharmacological prophylaxis of PDPH (post-dural puncture headache) after spinal anaesthesia for Caesaren section? Przegl Lek 2012;69:19-24.  Back to cited text no. 13
    
14. Yousefshahi F, Dahmardeh AR, Khajavi M, Najafi A, Khashayar P, Barkhordari K. Effect of dexamethasone on the frequency of postdural puncture headache after spinal anesthesia for cesarean section: A double-blind randomized clinical trial. Acta Neurol Belg 2012;112:345-50.  Back to cited text no. 14
[PUBMED]    
15. Doroudian MR, Norouzi M, Esmailie M, Tanhaeivash R. Dexamethasone in preventing post-dural puncture headache: A randomized, double-blind, placebo-controlled trial. Acta Anaesthesiol Belg 2011;62:143-6.  Back to cited text no. 15
[PUBMED]    
16. Ghaleb A, Khorasani A, Manar D. Post-dural puncture headache. Int J Gen Med 2012;5:45-51.  Back to cited text no. 16
    
17. Lenelle L, Lahaye-Goffart B, Dewandre PY, Brichant JF. Post-dural puncture headache: Treatment and prevention. Rev Med Liege 2011;66:575-80.  Back to cited text no. 17
[PUBMED]    
18. Darvish B, Gupta A, Alahuhta S, Dahl V, Helbo-Hansen S, Thorsteinsson A, et al. Management of accidental dural puncture and post-dural puncture headache after labour: A Nordic survey. Acta Anaesthesiol Scand 2011;55:46-53.  Back to cited text no. 18
[PUBMED]    
19. Anderson M. The properties of aminophylline. Emerg Nurse 2007;15:24-7.  Back to cited text no. 19
    
20. Donaldson D, Sundermann R, Jackson R, Bastani A. Intravenous dexamethasone vs placebo as adjunctive therapy to reduce the recurrence rate of acute migraine headaches: A multicenter, double-blinded, placebo-controlled randomized clinical trial. Am J Emerg Med 2008;26:124-30.  Back to cited text no. 20
[PUBMED]    
21. Kelly AM, Kerr D, Clooney M. Impact of oral dexamethasone versus placebo after ED treatment of migraine with phenothiazines on the rate of recurrent headache: A randomised controlled trial. Emerg Med J 2008;25:26-9.  Back to cited text no. 21
[PUBMED]    
22. Rowe BH, Colman I, Edmonds ML, Blitz S, Walker A, Wiens S. Randomized controlled trial of intravenous dexamethasone to prevent relapse in acute migraine headache. Headache 2008;48:333-40.  Back to cited text no. 22
[PUBMED]    
23. Tasch MD. Corticosteroids and anesthesia.Curr Opin Anaesthesiol 2002;15:377-81.  Back to cited text no. 23
[PUBMED]    
24. Yamaguchi M. [Drug allergy]. Arerugi 2012;61:753-9.  Back to cited text no. 24
[PUBMED]    
25. Travers AH, Jones AP, Camargo CA Jr, Milan SJ, Rowe BH. Intravenous beta(2)-agonists versus intravenous aminophylline for acute asthma. Cochrane Database Syst Rev 2012;12:102-56.  Back to cited text no. 25
    
26. Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: Systematic review and meta-analysis. Br J Anaesth 2013;110:191-200.  Back to cited text no. 26
[PUBMED]    
27. Hamzei A, Basiri-Moghadam M, Pasban-Noghabi S. Effect of dexamethasone on incidence of headache after spinal anesthesia in cesarean section. A single blind randomized controlled trial. Saudi Med J 2012;33:948-53.  Back to cited text no. 27
[PUBMED]    
28. Sadeghi SE, Rahimian MN, Razmi R, Abdollahfard GH. Effect of intravenous single dose of aminophylline on prevention of post-dural puncture headache in patients who underwent spinal anesthesia. J Gorgan Uni Med Sci 2010;12:24-8 [Persian].  Back to cited text no. 28
    
29. Sadeghi SE, Abdollahifard GR, Nasabi NS, Mehrabi M, Safarpour AR. Effectiveness of single dose intravenous aminophylline administration on prevention of post dural puncture headache in patients who received spinal anesthesia for elective cesarean section. World J Med Sci 2012;7:13-6.  Back to cited text no. 29
    
Advanced Biomedical Research
Volume 2014, January
January 2014
Pages 1-6