Alam Md Rabiul, Rahman Md Aminur, Ershad Reza
Department of Anaesthesia and Intensive Care, Combined Military Hospital, Chittagong, Bangladesh.
J Anaesthesiol Clin Pharmacol. 2012 Apr;28(2):190-3. doi: 10.4103/0970-9185.94840.
Headache is not an uncommon complication of spinal anesthesia. The efficacy of intravenous (IV) hydrocortisone in treating the patients with postdural puncture headache was observed in this study.
Sixty patients with headache following spinal anesthesia were randomly allocated into two groups. Thirty patients received only conventional therapy (recumbent positioning, IV or oral hydration, analgesics with caffeine, stool softeners, and soft diet) plus 2 ml of normal saline IV (placebo) 8 hourly for 48 h. Thirty other patients received conventional therapy plus hydrocortisone IV (100 mg in 2 ml 8 hourly for 48 h). Headache intensity was measured using visual analogue scale.
No significant difference was observed in baseline headache intensity between the two groups (P = 0.6642) before beginning of treatment. After 6 h, the mean headache intensity in patients treated conventionally was 6.02 ± 2.46, while it was 2.06 ± 1.98 in other patients who received additional hydrocortisone IV (P < 0.0001). After 24 h, headache intensity was 3.77 ± 1.85 in conventionally treated group versus 0.94 ± 2.67 in hydrocortisone group (P < 0.0001), while it was 1.95 ± 1.12 in conventionally treated group versus 0.69 ± 1.64 in hydrocortisone group (P = 0.001) after 48 h.
Very short-term use of IV hydrocortisone was found effective in reducing headache following spinal anesthesia. However, its clear mechanism of action is yet to be determined. Large-scale studies are recommended to consider the steroid therapy as a standard treatment for postdural puncture headache.
头痛是脊髓麻醉并不罕见的并发症。本研究观察了静脉注射氢化可的松治疗硬膜穿刺后头痛患者的疗效。
60例脊髓麻醉后头痛患者随机分为两组。30例患者仅接受常规治疗（卧位、静脉或口服补液、含咖啡因的镇痛药、软化大便剂及软食），并每8小时静脉注射2 ml生理盐水（安慰剂），共48小时。另外30例患者接受常规治疗加静脉注射氢化可的松（2 ml含100 mg，每8小时一次，共48小时）。使用视觉模拟量表测量头痛强度。
治疗开始前，两组患者的基线头痛强度无显著差异（P = 0.6642）。6小时后，接受常规治疗的患者平均头痛强度为6.02±2.46，而接受额外静脉注射氢化可的松的其他患者为2.06±1.98（P < 0.0001）。24小时后，常规治疗组头痛强度为3.77±1.85，氢化可的松组为0.94±2.67（P < 0.0001）；48小时后，常规治疗组为1.95±1.12，氢化可的松组为0.69±1.64（P = 0.001）。
发现短期静脉注射氢化可的松可有效减轻脊髓麻醉后的头痛。然而，其确切作用机制尚待确定。建议进行大规模研究，将类固醇疗法作为硬膜穿刺后头痛的标准治疗方法。
