Effectiveness of Nebulised Dexmedetomidine for Treatment of Post Dural Puncture Headache in Parturients undergoing Elective Caesarean Section under Spinal Anaesthesia: A Randomised Controlled Study

Introduction: Post Dural Puncture Headache (PDPH) following neuraxial anaesthesia is a common complication that can result in prolonged hospital stays. Central neuraxial anaesthesia remains the preferred technique for elective caesarean sections, and obstetric patients experience more intense PDPH compared to other patient categories. Aim: To evaluate the efficacy of nebulised Dexmedetomidine (DEX), a novel modality of treatment for PDPH. Materials and Methods: This double-blinded randomised controlled study was conducted at Department of Anaesthesiology SRM Medical College Hospital & Research Centre, Tamil Nadu, India. It was approved by the Institutional Ethics Committee and registered with the Clinical Trials Registry-India. After obtaining informed written consent from 60 patients, they were allocated into two groups. Group 1 received nebulisation with DEX, while Group 2 received nebulisation with 0.9% saline. Both groups received conservative management. Headache severity scores was compared as the primary outcome using a 5-point scale method, and the patient satisfaction scores as a secondary outcome using a Likert-type scale. One-way ANOVA, Student's t-test, Chi-square test, and two-tailed tests were used for statistical analysis. Results: The age distribution, Body Mass Index (BMI), needle size, and the number of spinal attempts were comparable between both groups. Patients who received DEX nebulisation (Group 1) showed a considerable improvement in pain scores (mean±standard deviation: 0.67±0.48) compared to patients who received nebulisation with 0.9% saline (Group 2) (mean±standard deviation: 1.87±0.35). The patient satisfaction score was better in Group 1 (mean±standard deviation: 4.87±0.35) compared to Group 2 (mean±standard deviation: 3.33±0.48). Two patients in Group 2 required an Epidural Blood Patch (EBP) (p-value <0.001). Conclusion: DEX nebulisation for PDPH was shown to be an effective treatment in reducing headache severity scores and alleviating PDPH symptoms in addition to conservative therapy, without causing side effects. Moreover, the DEX group displayed better haemodynamic stability compared to the placebo group.