Preventing spinal anesthesia headache in cesarean section: Randomized clinical trial

Post-dural puncture headache (PDPH) is a common complication following neuraxial block in cesarean sections, typically occurring 12-72 hours postoperatively and leading to considerable challenges and financial costs. We aimed to compare dexametha-sone and paracetamol for preventing spinal anesthesia headaches in cesarean sections.

A double-blind randomized clinical trial was conducted from December 2019 to April 2020. This study included 215 singleton pregnant women scheduled for elective cesarean section. To prevent PDPH, the patients were allocated to intravenous dexamethasone (n=70), paracetamol (n=75), and normal saline (n=70) groups. The primary outcomes were the incidence and severity of PDPH and VAS score evaluations. Secondary outcomes included recovery time, frequency of painkiller use, newborn Apgar scores, and patient satisfaction.

Significant time (p<0.001) and group (p=0.020) effects were observed on PDPH. At 48 hours postoperatively, patients receiving dexamethasone or paracetamol reported significantly lower PDPH severity compared to the normal saline group (p=0.009). The incidence of PDPH was also higher in the control group at 48 hours (p=0.033). No significant differences were observed among the groups in recovery time, analgesic use, Apgar scores at 1 and 5 minutes, or patient satisfaction (p>0.05).

Both paracetamol and dexamethasone had a positive impact on reducing the incidence and severity of PDPH compared to the normal saline group in cesarean sections (with dexamethasone showing a stronger effect). Recovery time, painkiller use, newborn Apgar scores, and patient satisfaction did not differ significantly between the groups. Further research is needed to validate these findings and ensure reproducibility.