Comparison between Aminophylline & Neostigmine/Atropine in Post Puncture Headache of Spinal Anesthesia in Caesarian Section

Background: Spinal anesthesia for Caesarian sections can lead to post-puncture headache (PPH). Neostigmine/Atropine and aminophylline are potential PPH treatments. PPH results from CSF leakage causing intracranial hypotension. Pharmacological options, including Aminophylline and Neostigmine/Atropine, offer innovative approaches to PPH management. Objectives: To compare between aminophylline and neostigmine/atropine in prevention of PPH . Patients and methods: The study included 50 female patients (ages 18-40, ASA I and II) undergoing spinal anesthesia. They were divided into two groups: Group I received aminophylline, and Group II received neostigmine plus atropine. Data on heart rate and blood pressure were collected before and after anesthesia induction. Postoperative monitoring included pain scores until reaching a VAS score ≤ 3. Results: The mean age of patients was 30.5 ± 8.8 years. Most patients (84%) were ASA I. Both groups had similar age distributions (P = 0.6) but slightly higher mean age in Group 1 (31.1 ± 9.9 years) compared to Group 2 (29.9 ± 7.9 years). No significant difference in ASA classification (P = 0.440). VAS scores differed significantly (P = 0.013) with neostigmine plus atropine group showing better scores. Nausea and vomiting incidence differed significantly (P = 0.018), with 40% in Group 2 and 12% in Group 1. Hemodynamic stability was similar (P = 0.203) with all Group 2 and 88% of Group 1 patients being stable. Conclusion: Neostigmine plus atropine provides better pain relief during spinal anesthesia for cesarean sections compared to aminophylline but may increase nausea and vomiting, requiring careful consideration in clinical decisions.