Abdelraouf Mhamed, Salah Maged, Waheb Mohsen, Elshall Ahmed
Cairo University, Cairo, Egypt.
Open Access Maced J Med Sci. 2019 Feb 19;7(4):549-552. doi: 10.3889/oamjms.2019.105. eCollection 2019 Feb 28.
Post-dural puncture headache (PDPH) is a common complication following neuraxial anaesthesia that increases the duration of hospital stay.
This study aims to evaluate the effectiveness of injection of the dexamethasone-lidocaine mixture in suboccipital muscles treatment of PDPH after cesarean section.
A group of 90 females with PDPH following cesarean section under spinal anaesthesia were randomly allocated into two equal groups: study group (Group S) and control group (group C). All patients received bilateral intramuscular (in the suboccipital muscle) (Group S) (n = 45) patients received lidocaine 40 mg (2 mL of 2% solution) and dexamethasone 8mg in a total volume of 4 mL; whilst, patients in the control group (group C) (n = 45) received 4 mL normal saline. The primary outcome is the Visual Analogue Score for a headache at 24 hours after injection.
Demographic data and the baseline, headache score, neck muscle spasm, and nausea were comparable in both groups. Group S showed lower headache score compared to group C at all the post-injection time points. All patients in group S showed resolution of nausea after the intervention; while none of the control group showed any improvement. All patients of group C needed rescue analgesia; while only 6 (13.3%) patients in group S asked for an analgesic. Time to the first analgesic request was longer in group S compared to group C (10.17 ± 7.96 hours versus 1.00 ± 0.00 hours, P < 0.001).
Ultrasound-guided injection of the dexamethasone-lidocaine mixture in suboccipital muscles is effective management of PDPH after CS.
硬膜穿刺后头痛（PDPH）是椎管内麻醉后常见的并发症，会延长住院时间。
本研究旨在评估枕下肌肉注射地塞米松 - 利多卡因混合液治疗剖宫产术后PDPH的有效性。
将一组90例在脊髓麻醉下行剖宫产术后发生PDPH的女性随机分为两组，每组45例：研究组（S组）和对照组（C组）。所有患者均接受双侧枕下肌肉内注射（S组）（n = 45）患者接受40 mg利多卡因（2%溶液2 mL）和8 mg地塞米松，总体积为4 mL；而对照组（C组）（n = 45）患者接受4 mL生理盐水。主要结局指标是注射后24小时的头痛视觉模拟评分。
两组的人口统计学数据、基线、头痛评分、颈部肌肉痉挛和恶心情况具有可比性。在所有注射后的时间点，S组的头痛评分均低于C组。S组所有患者干预后恶心症状消失；而对照组无一例有改善。C组所有患者均需要补救镇痛；而S组只有6例（13.3%）患者要求镇痛。S组首次镇痛请求的时间比C组长（10.17±7.96小时对1.00±0.00小时，P<0.001）。
超声引导下枕下肌肉注射地塞米松 - 利多卡因混合液是剖宫产术后PDPH的有效治疗方法。
