Comparison between Adding Intravenous Neostigmine and Atropine versus Intravenous Hydrocortisone for Conservative Treatment of Postdural Puncture Headache After spinal Anaesthesia For Elective Caesarean Section

Background Postdural puncture headache (PDPH) lacks a standard evidence-based treat- ment. A patient treated with neostigmine for severe PDPH And anther patient treated with hydrocortisone prompted this study. Objective To assess and compare the efficacy of intravenous neostigmine and atropine versus intravenous hydrocortisone as an adjuvant to conservative treatment of PDPH after spinal anaesthesia for elective caesarean section. Patients and Methods This study was carried out in Ain Shams University hospitals for six months (from February 2019 to August 2019) on 60 patients who presented with post dural puncture headache after elective caesarean section under spinal anaesthesia Results In this study, we compared the efficacy of hydrocortisone and neostigmine with conventional methods. All of the three groups (neostigmine, hydrocortisone and conventional methods) were effective in lowering VAS scores at 24, 48 and 72 h after headache's onset but neostigmine alleviated the pain more effectively and with rapid onset. The mean VAS score was significantly lower in neostigmine group compared with others 2, 6, 24, 48 and 72h after start of medications (p < 0.001 for all of them) and significantly lower in hydrocortisone group compared with Conventional group 6, 24, 48, and 72h (p < 0.001 for all of them). Conclusion neostigmine and hydrocortisone are both useful and safe in management of PDPH but neostigmine is more effective in this regard.

Treatment of postdural puncture headache: clinical case

The article describes a clinical case of the successful use of transnasal pterygopalatine ganglion blockade for the treatment of postdural puncture headache. The conditions for the application of this technique, the mechanism of its action, and the results are discussed. Results reveal the simplicity of the technical implementation of pterygopalatine ganglion blockade and the almost absent contraindications to its use, except for cases involving individual intolerance to topical anesthetic drugs. Hence, the technique can be an effective method for the complex therapy of postpunctional pain.