الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
This study was conducted at EL-Minia University Hospital during the period from October 2018 to October 2019; Approval for the study was given by our anaesthesia department and the ethical committee. All patients gave verbal consent before their inclusion in the study. A total of one hundred and fifty obstetric female patients in child bearing period (18-45yrs), belonging to ASA grad II undergoing elective caesarean section were selected.
Patients were randomly divided into three groups; group A: received IV ondansetron 8 mg diluted to 5 ml by normal saline.
group B: IV dexamethasone 8 mg diluted to 5 ml by normal saline.
group C: 5 ml normal saline
The aim of this study was to compare the effect of 8 mg ondansetron versus 8mg dexamethasone on incidence of post dural puncture headache as a primary outcome and nausea / vomiting as a secondary outcome .
Heart rate, ECG, arterial oxygen saturation and non-invasive blood pressure monitoring were applied before induction of anaesthesia using PCI monitor (model advisor USA).
The parameters that were assessed included: hemodynamics (HR, MAP), arterial oxygen saturation, quality of anaesthesia, maternal side effects. PDPH was also assessed regarding its incidence, onset, duration and severity. Also nausea and vomiting occurrence was assessed intraopertive and postoperative.
No significant differences in demographic and operative data were found between the 3 groups. Also, there was no significant difference regarding SpO2 among the 3 groups during the surgery.
In our study, out of the total 150 patients; 3, 4 and 12 patients had PDPH in group A, B and C respectively. There was a significant reduction in the incidence of PDPH with use of ondanetron in group A and dexamethasone in group B compared with control group. The administration of ondansetron and dexamethasone decreased the risk of PDPH. There was no statistical difference between group A and B regarding incidence of PDPH. None of the patients in group A or B had severe headache (headache of grade III). Four out of 12 patients in group C had severe headache. In the majority of cases, the onset of PDPH was in the 1st 48h and 3rd day except one case had headache by the 6th day in dexamesthasone group and 2 cases had headache by the 4th day in control group. Most of cases had maximum duration for headache up to 1 week and in little number of cases headache lasted for 2 weeks from onset of headache.
Nausea and vomiting (N/V) were monitored during intraoperative and postoperative periods till the end of the 4th day after the operation as, the incidence of nausea and vomiting was assessed in all groups as secondary outcome. Severity of N/V was scored as the following, 0 = no N/V, 1 = nausea alone, 2 = N/V, and 3 = N/V more than twice in 30 minutes. The incidence of intra operative nausea and/or vomiting in control group (42%) when compared with dexamethasone group (16%) and ondansetron group (8%). There was no statistical difference between dexamethasone group and ondansetron group. On the other hand, no PONV had occurred during the whole postoperative period in ondansetron group. While one case in the 1st 24h and 1 case during 24-48h had PONV in dexamethasone group. In control group, 4, 4 and 2 cases had PONV in the 1st 24h, 24-48h and 4th day respectively.
Our study revealed no significant difference between the three groups regarding hemodynamics.
Conclusion:
In conclusion, IV 8 mg ondansetron or IV 8mg dexamethasone 5 minutes before spinal anaesthesia in parturients undergoing elective CS produced a lower incidence of PDPH. Also, both drugs decrease the incidence of intraoperative and postoperative nausea and vomiting.