Soliman Omar M, Aboulfotouh Ahmed I, Abdelhafez Ahmed M, Abedalmohsen Abualauon
Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt -
Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt.
Minerva Anestesiol. 2023 Oct;89(10):867-875. doi: 10.23736/S0375-9393.22.16906-3. Epub 2023 Jan 18.
Post-dural puncture headache (PDPH) is one of the most common complications of neuraxial anesthesia after an accidental dural puncture. This study aimed to test non-interventional alternatives to treat PDPH. Our goals were to compare the effectiveness of nebulized dexmedetomidine (DEX) versus neostigmine/atropine in the conservative management of PDPH.
A randomized double-blind controlled study of ninety (90) women divided into three equal groups: group C (given nebulization of saline 0.9% placebo in four mL), group N (given nebulization of 20 µ/kg neostigmine and 10 µ/kg atropine diluted in four mL normal saline), and group D (given nebulization of dexmedetomidine 1 µg/kg diluted in four mL normal saline). Nebulization was done twice daily for three days, and a Visual Analogue Scale pain score (VAS) was recorded for seventy-two hours after the intervention for the three groups with a VAS Score equal or less than three being the cutoff value.
VAS was significantly decreased in dexmedetomidine, and neostigmine/atropine groups compared to the control group at six hours (median VAS: 5, 2, and 2 for groups C, N, and D respectively [P=0.001]). There was a significant difference in VAS trends between the three groups (at six, twelve, twenty-four, thirty-six, and forty-eight hours [P=0.001], and at seventy-two hours [P=0.003]). No patients in group D, but one patient in group N and seven patients in group C needed an epidural blood patch.
Nebulized dexmedetomidine and neostigmine/atropine had a rapid effect on relieving PDPH after cesarean section.
硬膜穿刺后头痛（PDPH）是意外硬膜穿刺后最常见的神经轴索麻醉并发症之一。本研究旨在测试治疗PDPH的非介入性替代方法。我们的目标是比较雾化右美托咪定（DEX）与新斯的明/阿托品在PDPH保守治疗中的有效性。
一项随机双盲对照研究，将90名女性分为三组，每组人数相等：C组（给予4 mL 0.9%生理盐水安慰剂雾化）、N组（给予20 µ/kg新斯的明和10 µ/kg阿托品在4 mL生理盐水中稀释后雾化）和D组（给予1 µg/kg右美托咪定在4 mL生理盐水中稀释后雾化）。雾化每天进行两次，持续三天，三组在干预后72小时记录视觉模拟量表疼痛评分（VAS），VAS评分等于或小于3为临界值。
与对照组相比，右美托咪定组和新斯的明/阿托品组在6小时时VAS显著降低（C组、N组和D组的中位VAS分别为5、2和2 [P = 0.001]）。三组之间的VAS趋势存在显著差异（在6、12、24、36和48小时时[P = 0.001]，以及在72小时时[P = 0.003]）。D组无患者需要硬膜外血贴，但N组有1名患者，C组有7名患者需要硬膜外血贴。
雾化右美托咪定和新斯的明/阿托品对剖宫产术后缓解PDPH有快速效果。
