Prophylactic Effects of Hydrocortisone on Post Dural Puncture Headache after Spinal Anesthesia

Abstract

Background: Post-dural puncture headache is one of the common complications after neuraxial anesthesia. Some researchers have used corticosteroids for treatment of this complication. We decided to study the prophylactic effect of administering intravenous hydrocortisone before spinal anesthesia in reducing the incidence and intensity of headache after surgery. Methods: This randomized, double-blind, placebo-controlled trial was carried out in 80 patients undergoing abdominal and lower limb surgery without other health problem (ASA I). We randomly put 40 participants in the placebo group and 40 in the hydrocortisone group for study. The placebo group received 2 ml placebo and hydrocortisone group received 2 ml (100 mg) intravenous hydrocortisone. The incidence of PDPH on the recovery, 12, 24, 48 hours and 7 days after surgery was studied, and the severity of PDPH was assessed using a visual analog scale (VAS). Results: The mean intensity of headache in hydrocortisone group after recovery in the first 12, 24 and 48 hours and the first week of surgery were 0.0, 1.27, 2.35, 2.28 and 0.97 mm whereas in placebo group they were 0.0, 2.02, 3.02, 2.92 and 1.47 mm. The difference of headache intensity between two groups was not significant (P=1, P=0.231, P=0.344, P=0.351, and P= 0.302). The difference of incidence rate between two groups was not significant (P= 1, P=0,502, P=0.633, P=0,579 and p= 0,576). Conclusion: The results indicated that prophylactic administration of 100 mg hydrocortisone did not have any protective effect against post dural puncture headache.

Keywords

• hydrocortisone
• dural puncture
• headache
• spinal anesthesia