الفهرس 
POST-DURAL PUNCTURE HEADACHEOnly 14 pages are availabe for public view
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Abstract
¬Neuraxial anaesthesia is very effective anaesthesia especially if the surgical site below the umbilicus level.
PDPH is one of the most common complications of diagnostic, therapeutic or inadvertent lumbar punctures. PDPH is defined as any headache after a lumbar puncture that worsens within 15 minutes of sitting or standing and is relieved within 15 minutes of lying down. Ninety per cent of PDPH occur within three days of the procedure and 66% start in the first 48 hours.
The features of PDPH are often variable. PDPH may be accompanied by neck stiffness, tinnitus, hearing loss, photophobia or nausea; other features, such as the location and duration, are also unpredictable.
Many Pharmacologic interventions offer a safe and effective alternative to an EBP. Pharmacological options for management include NSAIDs, steroids, Methylxanthine derivatives, sumatriptans, gabapentinoids & Neostigmine – Atropine.
Aminophylline is a methylxanthine that contains theophylline and ethylenediamine in a 2:1 ratio. Methylxanthines decrease cerebral blood flow, increase cerebral vascular resistance, and increase cerebral vasoconstriction.
Acetaminophen is a p-aminophenol derivative with analgesic and antipyretic activities. Acetaminophen may inhibit the nitric oxide (NO) pathway mediated by a variety of neurotransmitter receptors including N-methyl-D-aspartate (NMDA) and substance P, resulting in elevation of the pain threshold.
The aim of this study was to compare the efficacy of aminophylline compared to acetaminophen in management of PDPH.
70 patients were included in this clinical trial aged between 18 – 60 years old, class I – II according to the American society of anaesthesiology having a headache that developed after Dural puncture for various surgical procedures under regional anaesthesia (spinal anaesthesia, epidural anaesthesia or combined spinal and epidural anaesthesia) at Nasr City Insurance hospital and Ain Shams university hospitals.
Patients were randomly allocated into 2 groups (35 patients each). group (A) received 250mg Aminophylline & group (B) received 1gm paracetamol.
Once diagnosis was confirmed, patients gave a written informed consent & randomly allocated in one of the two study groups, Baseline VAS scores were recorded before drug administration. VAS scores were recorded again at 2 hours, 6 hours and 12 hours after the treatment administration.
The primary end point was the headache severity after 8 – 12 hours after treatment
The secondary outcomes were the overall response to treatment measured on the Patient Global impression of change (PGIC) which was assessed using PGIC scores table in the bedside cards.
There was no statistically significant difference between the two groups according to demographic data including: Age, Sex, Weight, American Society of Anaesthesiology classification (ASA), Duration of surgery & Duration of hospital stay.
By comparing the headache intensity between 2 groups, Mean VAS scores for PDPH intensity were statistically significant lower in group A compared to group B, while baseline VAS Score for PDPH intensity was insignificant statistically between Both Groups.
On the Patient Global impression of change (PGIC), 26 patients in group A reported that their pain symptoms were much improved or very much improved, while 18 patients in group B reported the same.
Also only 8 patients in group A stated that there was no change in their pain symptoms while 14 patients in group B stated the same.