Oral multidose caffeine-paracetamol combination is not effective for the prophylaxis of postdural puncture headache

To investigate the effects of different doses of oral caffeine-paracetamol combinations in postdural puncture headache (PDPH) prophylaxis.

Prospective, randomized, placebo-controlled, blinded study.

University hospital.

A total of 210 ASA physical status I and II patients undergoing lower extremity surgery.

Patients were randomly divided into 3 groups. One hour before the spinal anesthesia, the first group (n = 70) received placebo, the second group (n = 70) received 500-mg paracetamol + 75-mg caffeine, and the third group (n = 70) received 500-mg paracetamol + 125-mg caffeine orally. The same doses were repeated every 6 hours for 3 days. Patients were then interviewed on days 1, 2, 3, 4, and 7 to inquire about any PDPH. The interviewer was unaware of the PDPH prophylaxis group members. Patients who were discharged early were interviewed by telephone.

Postdural puncture headache occurred in 11 patients (15.7%) in group 1, 10 patients (% 14.28) in group 2, and 10 patients (% 14.28) in group 3. The differences between the groups were insignificant (P > .05). The complications due to spinal anesthesia were similar in the 3 groups. Side effects of caffeine such as lack of sleep, tachycardia, and hypertension were not observed in groups 2 or 3.

Prophylactic administration of paracetamol-caffeine combinations at the stated doses does not prevent PDPH.