Research Article

Prophylactic Effects of Hydrocortisone on Post Dural Puncture Headache after Spinal Anesthesia

Abstract

Background: Post-dural puncture headache is one of the common complications after neuraxial anesthesia. Some researchers have used corticosteroids for treatment of this complication.
We decided to study the prophylactic effect of administering intravenous hydrocortisone before spinal anesthesia in reducing the incidence and intensity of headache after surgery.
Methods: This randomized, double-blind, placebo-controlled trial was carried out in 80 patients undergoing abdominal and lower limb surgery without other health problem (ASA I). We randomly put 40 participants in the placebo group and 40 in the hydrocortisone group for study. The placebo group received 2 ml placebo and hydrocortisone group received 2 ml (100 mg) intravenous hydrocortisone. The incidence of PDPH on the recovery, 12, 24, 48 hours and 7 days after surgery was studied, and the severity of PDPH was assessed using a visual analog scale (VAS).
Results: The mean intensity of headache in hydrocortisone group after recovery in the first 12, 24 and 48 hours and the first week of surgery were 0.0, 1.27, 2.35, 2.28 and 0.97 mm whereas in placebo group they were 0.0, 2.02, 3.02, 2.92 and 1.47 mm. The difference of headache intensity between two groups was not significant (P=1, P=0.231, P=0.344, P=0.351, and P= 0.302). The difference of incidence rate between two groups was not significant (P= 1, P=0,502, P=0.633, P=0,579 and p= 0,576).
Conclusion: The results indicated that prophylactic administration of 100 mg hydrocortisone did not have any protective effect against post dural puncture headache.

Jacobus CH. Does Bed Rest Prevent Post–Lumbar Puncture Headache? Ann Emerg Med. 2012; 59(2): 139-40.

Frank RL. Lumbar Puncture and post – dural puncture headaches: implications for emergency physician. J Emerg Med. 2008; 35(2):149-57.

Turnbull D, Shepherd DB. post – dural puncture headaches: pathogenesis, Prevention and treatment. Br J Anaesth. 2003; 91(5):718-29.

Apfel C, Saxena A, Cakmak kaya OS, Gaiser R, George E, Radke O. Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review. Br J Anaesth. 2010; 105(3):255-63.

Charsley mm, Abram SE. The injection of intrathecal normal saline reduces the severity of postdural puncture headache. Reg Anesth Pain Med. 2001; 26(4):301-5.

Hamzei A, Bashiri Moghaddam 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(9): 948-53.

Boyle JA, Stocks GM. Post-dural puncture headache in the parturient – an update. Anaesthesia & Intensive Care Medicine. 2010; 11 (8): 302-4.

Alam MR, Raheen MR, Iqbal KM, Chowdhury MRA. Headache following spinal anaesthesia: a review on recent update. J Bangladesh Coll Phys Surg. 2011; 29 (1): 32-40.

Ergün U, Say B, Ozer G, Tunc T, Sen M, Tüfekcioglu S, et al. Intravenous theophylline decreases post – dural puncture headaches. J Clin Neurosci. 2008; 15(10): 1102-4.

Huseyinoglu U, Huseyinoglu N, Aygun H, Sulu B. Effect of pregabalin on post – dural puncture headache following spinal anaesthesia and lumbar puncture. J Clin Neurosci. 2011; 18(10):1365-8.

Rahmawy, Ghada El, Doaa Rashwan, Nashwa NM. The efficacy of preoperative pregabalin on reduction of the incidence and severity of postdural puncture headache after spinal anesthesia. Egyptian journal of Anesthesia. 2013; 29 (4): 357.

Basurto Ona X, Uriona Tuma SM, Martinez Garcia L, Sola I, Bonfill Cosp X. Drug therapy for preventing post – dural puncture headache. Cochrane Database Syst Rev. 2013; 28 (2): CD001792.

Ghaleb A, Arjang K, Devanand M. post – dural puncture headache. Int J Gen Med. 2012; 5: 45–51.

Doroudian MR, Norouzi M, Esmaili M, Tanhaeivash R. Dexamethasone in preventing post – dural puncture headaches: a randomized, double – blind, placebo – controlled trial. Acta Anaesthesiol Belg. 2011; 62(3):143-6.

Alam MR, Rahman MA, Ershad R. Role of very short-term intravenous hydrocortisone in reducing postdural puncture headache. J Anaesthesiol Clin Pharmacol. 2012; 28 (2):190-3.

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(4):345-50.

Hong M, Shah Gv, Adams Km, Turner Rs, Foster NI. Spontaneous intracranial hypotension causing reversible frontotemporal dementia. Neurology. 2002; 58(8):1285-7.

Gentile S, Giudice R L, Martino PD, Rainero I, Pinessi L. Headache attributed to spontaneous low CSF pressure: report of three cases responsive to corticosteroids. Eur J Neurol. 2004; 11(12):849-51.

Yang B, Li DL, Dong P, Zhang XY, Zhang L, Yu JG. Effect of dexamethasone on the incidence of post-dural puncture headache after spinal anesthesia: a randomized, double-blind, placebo-controlled trial and a meta-analysis. Acta Neurol Belg. 2015; 115(1):59-67.

Pascual LF, Santos S, Escalza I, Iniguez C, Morales – Asin F. Spontaneous intracranial hypotension: Quick clinical and magnetic resonance imaging response to corticosteroids. A case report. Headache. 2002; 42 (5): 359-61.

Bezov D, Lipton RB, Ashina S. post-dural puncture headaches: Diagnosis, Epidemiology, Etiology, and pathophysiology. Headache. 2010; 50 (7) 1144-52.

Miyazawa K, Shiga Y, Hasegawa T, Endoh M, Okita N, Higano S, et al. CSF hypovolemia vs. intracranial hypotension in spontaneous intracranial hypotension syndrome. Neurology. 2003; 60 (6): 941-7.

Graeme PC, Paterson ED, Keenan F, Nath S, Watt SJ. An unexpected response to intravenous hydrocortisone succinate in an asthmatic patient. Br J Clin Pharmacol. 2005; 60 (3): 342.

Gilron I. Corticosteroids in postoperative pain management: Future research direction for a multifaceted therapy. Acta Anaesthesiol Scand. 2004; 48(10): 1221-2

Elenkov IJ, Chrousos GP. Stress Hormones, Proinflammatory and Anti in inflammatory Cytokines, and Autoimmunity. Ann N y Acad Sci. 2002; 966: 290-303.

Files
IssueVol 4 No 1 (2018): Winter QRcode
SectionResearch Article(s)
Keywords
hydrocortisone dural puncture headache spinal anesthesia

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Mortazavi MT, Ansari Kazaj M, Movassaghi R. Prophylactic Effects of Hydrocortisone on Post Dural Puncture Headache after Spinal Anesthesia. Arch Anesth & Crit Care. 2018;4(1):426-429.