[Is there any point in pharmacological prophylaxis of PDPH (post-dural puncture headache) after spinal anaesthesia...

To assess the effectiveness of postoperatively applied pharmacological prophylaxis and the impact of demographic parameters (age, height, weight), gestational age, parturients' morbidity (hypertension, motion sickness), postoperative fluid resuscitation, applied anaesthetic technique (spinal needle type and diameter, patient's positioning, choice of intervertebral space for puncturing dura, a dose of local anaesthetic) on the incidence of PDPH after spinal anaesthesia for Caesarean section.

There were analyzed 182 mothers who delivered by Caesarean section under spinal anaesthesia. Postoperative management included fluid administration 2500 ml daily and i.v. antibiotic prophylaxis (control group, n = 560). The consecutive groups of patients were administered antibiotic and fluids in dose as mentioned above, and additionally oral caffeine 3 x 200 mg (n = 40); caffeine plus magnesium 2 x 1 g daily i.v. (n = 42) or caffeine plus magnesium plus aminophylline 250 mg i.v. once daily (n = 40). Incidence of PDPH was analyzed in all the groups of patients.

The incidence of PDPH was lower after usage of thin spinal needles (Spinokan 27G), but statistical significance was p = 0.07. The other analyzed factors did not affect the incidence of PDPH. None of the applied pharmacoprophylactic methods appeared to be efficacious. The volume of administered within 18 hours postoperatively crystalloids was larger in the group of patients with multifactorial pharmacoprophylaxis (p = 0.04), probably due vasodilatation caused by synergistic effect of magnesium and aminophylline; explanation of this phenomenon is arguable, however.

Neither prophylactic administration of caffeine, magnesium or aminophylline, nor postoperative fluid administration, did not influence the incidence of PDPH.