Comparison between different intravenous regimens for prevention of post dural puncture headache after spinal anesthesia for elective cesarean section

Background and aim Cesarean sections have become more prevalent nowadays, so it lower maternal death and illness. Spinal anesthesia has some side effects as postdural puncture headache (PDPH). This study aimed to compare intravenous neostigmine, aminophylline, and Synacthen for avoidance of PDPH after spinal anesthesia for nonurgent cesarean delivery. Patients and methods A randomized experimental study directed on 100 patients, underwent an elective cesarean delivery under spinal anesthesia. Participants were divided into four equal groups: group N: received 20 μg/kg neostigmine +10 μg/kg atropine, group A: received 250 mg aminophylline, group S: received 1 mg Synacthen in 20 ml, and group C: received 20 ml saline (all put in 20 ml saline over 20 min every 24 h for 72 h). Results The different groups showed no significant difference regarding the noninvasive blood pressure and heart rate. The severity of headache was significantly lower in group N, group A, and group S than group C ( P <0.05). Severity score of headaches was insignificantly different at postanesthesia care unit, 2, 4, 6, 12, 24, 48, and 72 h among the four groups. Incidence of headache was significantly lower at 18 and 24 h in group N, group A, and group S than in group C ( P <0.05). Onset and duration of headache and intraoperative nausea and vomiting were irrelevantly distinct among the four groups. Conclusion The administration of neostigmine, aminophylline, and Synacthen demonstrated comparable efficacy in preventing PDPH following spinal anesthesia for elective cesarean section regarding hemodynamic parameters, headache severity, incidence, onset, duration, and the intraoperative nausea and vomiting.