Role of prednisolone in management of post-dural puncture headache after spinal anesthesia in obstetric patients

Abstract

Background and Aims: Post-dural puncture headache (PDPH) is a common cause of morbidity in patients subjected to dural puncture for spinal anesthesia. PDPH is mostly a benign condition but can lead to delayed hospital discharge and considerable morbidity for the parturient. We aimed to study whether there is a positive role of prednisolone in post dural puncture headache management (after spinal anesthesia) in patients undergoing lower segment cesarean section (LSCS).
Methodology: A randomized controlled trial was conducted at department of gynecology and obstetrics, in Combined Military Hospital (CMH), Nowshera, from April 2018-September 2018. A sample size of 60 patients was determined through WHO calculator. Patients were selected through non probability consecutive sampling after ethical committee approval and consent forms were taken. Patients were randomly categorized into two groups. Group A was given tablet prednisolone while Group B was given a placebo tablet. Patients were followed for pain measurement using visual analogue scale (VAS). Data were analyzed using SPSS version 24. T-test and Chi-square test were applied. A p ≤ 0.05 was considered significant.
Results: A total of 60 women undergone c sections were included in study. Mean age of women was 28.5 years ± 4.3. Mean pain scores were significantly reduced in prednisolone group as compared to placebo at 24, 48, 72 and 96 h (p = 0.00). Majority of patients in placebo group had severe headache as compare to oral prednisolone group after 96 h (p = 0.00).
Conclusion: Post-Dural Puncture Headache is a major complications following LSCS in spinal anesthesia. Oral prednisolone usage is very effective in lowering severity of headache and duration of PDPH. Oral prednisolone also limits adverse events associated with PDPH after LSCS performed in spinal anesthesia.
Citation: Afridi N, Fareed A, Fatima A, Role of prednisolone in management of postdural puncture headache after spinal anesthesia in obstetric patients . Anaesth. pain & intensive care 2019;23(2):168-171