Aminophylline versus Ketamine in prophylaxis against post-dural puncture headache in pregnant females undergoing cesarean section: A comparative study

Background: Post-dural puncture headache (PDPH) is a significant cause of maternal comorbidity and dissatisfaction following cesarean section (CS) under spinal anesthesia.Objective: The aim of this study was to assess the efficacy and safety of intravenous administration of aminophylline and ketamine for the prevention of PDPH in patients undergoing elective CS with spinal anesthesia.Methods: This double-blinded, parallel-group, randomized trial enrolled adult parturients with American Society of Anesthesiologists I-II who were scheduled for elective CS under spinal anesthesia. A total of 100 participants were randomized to two groups (50 participants each). Group A received 1.5 mL/kg of intravenous aminophylline, while Group B received 0.15 mg/kg of intravenous ketamine. The primary outcomes were the incidence and severity of PDPH. Secondary outcomes included need for paracetamol and incidence of nausea and vomiting, pruritus, and hypotension episodes.Results: We found no significant differences between the two groups in any of the baseline characteristics (all p > 0.05). Compared to group B, participants in group A had a lower incidence and severity of PDHD both intraoperatively and postoperatively at 2, 6, 12, and 24 hours, but without statistical significance (all p > 0.05). However, at 48 hours postoperatively, group A had significantly fewer patients with PDHD and lower pain severity compared to group B (p = 0.022 and 0.022, respectively).Conclusion: Intravenous administration of aminophylline or ketamine are effective and safe methods for reducing the incidence and severity of PDPH in patients undergoing elective CS with spinal anesthesia.