Amini Nazanin, Modir Hesameddin, Omidvar Safoora, Kia Mansoreh Karimi, Pazoki Shirin, Harorani Mehdi, Moradzadeh Rahmatollah, Derakhshani Maryam
Department of Anesthesia, School of Paramedical Sciences, Arak University of Medical Sciences, Arak, Iran.
Department of Anesthesiology, School of Nursing and Midwifery, Arak, Iran.
J West Afr Coll Surg. 2022 Oct-Dec;12(4):102-116. doi: 10.4103/jwas.jwas_183_22. Epub 2022 Nov 23.
Spinal anaesthesia (SA) is a common method during surgery due to easy administration, rapid effects, relaxes muscles and controls pain. But, post-dural puncture headache (PDPH) is a common problem after SA that occurs in 6%-36% of SA. We assessed the effect of four common treatment drugs sumatriptan, theophylline, pregabalin and oral caffeine on prevention of PDPH. In this systematic review, all randomized clinical trials (RCTs) during January 2015 and December 2021 were searched from PubMed, Google Scholar, Web of Science, Cochrane review and Clinical Key with a specific search strategy. The article qualities were assessed by two independent authors and were screened for relevant sources based on inclusion and exclusion criteria. Moreover, the included articles data were extracted and checked for regular basis. A total of 421 articles were identified and 193 articles were removed following a preliminary review and finally, 14 articles were included in review. Overall, we identified five RCTs on the effect of caffeine, two RCTs on the effect of sumatriptan, three RCTs on theophylline, three RCTs on pregabalin and one RCT on theophylline and sumatriptan in PDPH prevention. This review supports the effects of theophylline, pregabalin and sumatriptan in the prevention of PDPH incidence and treatment of PDPH intensity, but we cannot draw the same conclusions about caffeine due to some negative results about the caffeine effect. Nevertheless, this extracted conclusion should be considered and interpreted with caution and limited generalizations due to the small number of studies, the variety of evaluated drugs and measures, the low sample size and the bias presented.
脊髓麻醉（SA）是手术中常用的方法，因其给药方便、起效迅速、能松弛肌肉并控制疼痛。但是，腰麻后头痛（PDPH）是SA后常见的问题，发生率为SA的6%-36%。我们评估了四种常用治疗药物舒马曲坦、茶碱、普瑞巴林和口服咖啡因对预防PDPH的效果。在这项系统评价中，采用特定的检索策略，从PubMed、谷歌学术、科学网、考克兰系统评价和临床要点中检索了2015年1月至2021年12月期间的所有随机临床试验（RCT）。由两名独立作者评估文章质量，并根据纳入和排除标准筛选相关文献。此外，对纳入文章的数据进行提取并定期检查。共识别出421篇文章，经过初步筛选后排除193篇文章，最终纳入14篇文章进行综述。总体而言，我们确定了五项关于咖啡因效果的RCT、两项关于舒马曲坦效果的RCT、三项关于茶碱的RCT、三项关于普瑞巴林的RCT以及一项关于茶碱和舒马曲坦预防PDPH的RCT。本综述支持茶碱、普瑞巴林和舒马曲坦在预防PDPH发生率和治疗PDPH严重程度方面的效果，但由于关于咖啡因效果的一些负面结果，我们不能对咖啡因得出同样的结论。然而，由于研究数量少、评估药物和措施多样、样本量小以及存在偏差，这一得出的结论应谨慎考虑和解读，且推广范围有限。
