Effects of Dexamethasone on Post-dural Puncture Headache in Patients Undergoing Orthopedic Surgery



Hadis Barkhori1, Farhad Arefi2, Kiavash Hushmandi3, Salman Daneshi4, Jafar Salehi5, *, Hamideh Barkhori6, Hamid Rafee7, Mehdi Raei8, Leila Karimi9
1 School of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran
2 Department of Nursing, School of Nursing, Jiroft University of Medical Sciences, Jiroft, Iran
3 Department of Food Hygiene and Quality Control, Division of Epidemiology & Zoonoses, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
4 Department of Public Health, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran
5 Department of Anesthesiology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
6 Imam Khomeini Hospital, Jiroft University of Medical Sciences, Jiroft, Iran
7 Research Center of Prevention and Epidemiology of Non-Communicable Disease, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
8 Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
9 Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran


© 2020 Barkhori et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Anesthesiology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran; Tel: +989197615525; E-mail: Dr.jsalehi@gmail.com


Abstract

Background:

The effect of Dexamethasone on Post-Dural Puncture Headache (PDPH) after spinal anesthesia has not been well elucidated. The aim of the current study was to evaluate the effect of prophylactic intravenous dexamethasone on the incidence and severity of PDPH in patients undergoing orthopedic surgery.

Methods:

This randomized, double-blind, placebo-controlled trial was carried out in patients undergoing orthopedic surgery. The subjects were randomly divided into a placebo (n=140) and a dexamethasone (n=140) group. During the surgery, the control group participants were injected 2cc of distilled water, and the dexamethasone group participants were injected 2cc (8mg) of dexamethasone as an infusion in the veins. The incidences of PDPH on the first, third and seventh postoperative days were studied. Data were analyzed using SPSS version 22.

Results:

A total of 280 patients with a mean age of 32.7 ± 11.0 years were studied. The incidence of PDPH on the first day of post-operative period was lower in the dexamethasone group than the control group (21 vs. 34, P<0.05). This difference was disappeared on days 3 and 7. Nausea or vomiting occurred less in the dexamethasone group (9 vs. 26, P<0.05). However, no statistically significant association was found between study groups and the incidence of back pain (P>0.05).

Conclusion:

Although the frequency of PDPH was less in patients receiving dexamethasone, the incidence increased days after the operation and reached the level of the placebo group. We do not recommend prophylactic intravenous dexamethasone for the prevention of PDPH.

Keywords: Dexamethasone, Post-Dural puncture headache, Anesthesia, Spinal, Orthopedic surgery, Back pain.