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. 2020 Nov;64(11):965-970.
doi: 10.4103/ija.IJA_49_20. Epub 2020 Nov 1.

Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial

Wegdan A Ali  1 , Mo'men Mohammed  2 , Ahmed R Abdelraheim  2
Affiliations

Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial

Wegdan A Ali et al. Indian J Anaesth. 2020 Nov.

Abstract

Background and aims: Postdural puncture headache (PDPH) is a side effect of spinal anaesthesia (SA). This study was conducted to investigate the effect of intrathecal fentanyl on the incidence, severity, and duration of PDPH.

Methods: This was a prospective randomised controlled study including 220 parturients, who underwent Caesarean section (CS). They were divided into two groups for administration of SA with bupivacaine (bupivacaine group [B0], n = 111) or bupivacaine with fentanyl (bupivacaine fentanyl group [BF], n = 109). Haemodynamics, quality of anaesthesia, maternal side effects, and postoperative analgesia were noted. The neonatal Apgar score was recorded. The patients were followed up for 14 days after CS for the occurrence of PDPH, and its severity and duration. The collected data were statistically analysed, using the Statistical Package for the Social Sciences software version 25.

Results: Regarding haemodynamics, heart rate increased at 5 min post-induction and blood pressure decreased at 2min post-induction in both groups. Excellent intraoperative anaesthesia was obtained in 91.7% and 79.3% of cases in groups BF and B0, respectively (P < 0.01). Longer duration of postoperative analgesia was present in the BF group as compared to the B0 group (P < 0.001). The incidence of PDPH decreased in the BF group in a non-significant manner, whereas its severity and duration increased significantly in the B0 group.

Conclusion: Although the addition of intrathecal fentanyl to bupivacaine for SA in CS patients did not reduce the incidence of PDPH significantly, its severity and duration decreased significantly.

Keywords: Caeserean section (CS); intrathecal fentanyl; postdural puncture headache.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of the study groups
Figure 2
Figure 2
Heart rate changes (bpm) in study groups
Figure 3
Figure 3
SBP and DBP in study groups. SBP- Systolic blood pressure; DBP-Diastolic blood pressure
See this image and copyright information in PMC

References

    1. Dabas R, Lim MJ, Sng BL. Postdural puncture headache in obstetric neuraxial anaesthesia: Current evidence and therapy. Trends Anaesth Crit Care. 2019;25:4–11.
    1. Srivastava U, Agrawal A, Gupta A, Dwivedi Y, Pilendran S, Shukla V. Intracranial subdural haematoma after spinal anaesthesia for caesarean section: Case report and review of literature. J Obstet Anaesth Crit Care. 2014;4:45–7.
    1. Bakshi SG, Gehdoo RS. Incidence and management of post-dural puncture headache following spinal anaesthesia and accidental dural puncture from a non-obstetric hospital: A retrospective analysis. Indian J Anaesth. 2018;62:881–6. - PMC - PubMed
    1. Nath S, Koziarz A, Badhiwala JH, Alhazzani W, Jaeschke R, Sharma S, et al. Atraumatic versus conventional lumbar puncture needles: A systematic review and meta-analysis. Lancet. 2018;391:1197–204. - PubMed
    1. Al-Metwalli RR. Epidural morphine injections for prevention of post dural puncture headache. Anaesthesia. 2008;63:847–50. - PubMed