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Neostigmine and atropine as a treatment for postdural puncture headache after spinal anesthesia in cesarean section:

Indra Kumar Shrestha1, Rupak Chalise1, Saroj Poudel1

  • 1Critical Care Medicine Nepal Mediciti Lalitpur Nepal.

Clinical Case Reports
|November 6, 2023
PubMed

Postdural puncture headache (PDPH) is a common consequence of cesarean section surgeries after spinal anesthesia. This case study describes the successful treatment of PDPH with intravenous neostigmine and atropine. A 31 years female who underwent elective cesarean section with spinal anesthesia developed a severe headache on the 6th postoperative day and was diagnosed to have PDPH. PDPH failed to respond to conventional treatment modalities like hydration, a Non-steroidal anti-inflammatory drug, and sphenopalatine ganglion block. Epidural blood patch could not be performed due to lack of consent. A trial dose of intravenous neostigmine (20 mcg/kg) along with atropine (10 mcg/kg) successfully provided symptomatic and clinical relief. The combination of neostigmine and atropine demonstrates a rapid onset of action, providing patients with effective analgesia while avoiding the need for invasive procedures such as epidural blood patches and offers quicker pain relief. This promising result warrants additional research.

Keywords:
PDPHatropineepidural blood patchintensive care unitneostigminespinal anesthesia

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