Dexamethasone in Preventing Post Dural Puncture Headache

Background and Aim: Post-dural puncture headache is major complication of spinal anesthesia that occurs in 40% of cases. Invasive treatment like an epidural blood patch might be required for post-dural puncture headache. The Dexamethasone effect on Post-Dural Puncture Headache following spinal anesthesia is not addressed and well understood. The aim of the present study was to assess the role of Dexamethasone in post-dural puncture headaches. Materials and Methods: This cross-sectional study was carried out on 456 patients who underwent spinal anesthesia from 16th April 2021 to 15th October 2021 at the department of Anesthesiology of Pakistan Ordnance Factories (POF)Hospital,WahCantt, Mayo Hospital, Lahore andMohi-ud-Din Teaching Hospital, Mirpur AJK. All the patients who underwent spinal anesthesia were enrolled whereas patients with previous headache disorder and contraindicated for steroids were excluded. Patients were allocated to two groups; Group A (Placebo) and Group B (Dexamethasone). Placebo group patients were injected with normal saline (2 mL) and other group patients with dexamethasone prophylactic epidural injection (2 mL, 8 mg). The incidence and severity of post-dural puncture headache and backache at the puncture site were evaluated on the 1st, 3rd, and 7th postoperative days. SPSS version 24 was used for data descriptive analysis. Results: A total of 456 patients underwent spinal anesthesia in which 228 patients over age of 20 years were assigned to each group. The prevalence of post-dural puncture headache was found lower in dexamethasone group patients 14 (6.2%) compared to normal saline 26 (11.6%) on the post-operative first day (p<0.05). However, on days 3 and 7, the difference disappeared. The overall prevalence of post-dural puncture headache was 21 (9.4%) in the dexamethasone group and 11 (4.7%) in the placebo group, which is statistically insignificant (p-value=0.132). There was no statistical significance in terms of headache severity (2.7% in the study group versus 7% controls group; p-value =0.128). The incidence of symptoms like vomiting or nausea occurred in a lower number of dexamethasone group patients compared to placebo. The prevalence of backache between the two groups was found insignificant. Conclusion: Our study found that the prevalence of post-dural puncture headache was lower in dexamethasone group patients but improved with increasing post-operative days and extended to the placebo group. Our findings contradict the earlier studies in regard to dexamethasone's effectiveness in post-dural puncture headache treatment. Based on our findings, dexamethasone cannot be recommended for post-dural puncture headaches. Keywords: Post-Dural puncture headache; Dexamethasone; Spinal Anesthesia