Role of Vitamin C Supplementation in the Prevention of Post-Dural Puncture Headache: A Randomized Controlled Trial

Post-dural puncture headache (PDPH) is a common complication following spinal anaesthesia, characterised by a postural headache that worsens on standing and improves when supine, with an incidence ranging from 1% to 30% depending on patient and procedural factors. It results primarily from cerebrospinal fluid leakage at the dural puncture site, leading to decreased intracranial pressure, compensatory cerebral vasodilation, and traction on pain-sensitive structures. Despite preventive measures such as atraumatic needles and minimising puncture attempts, PDPH remains clinically significant, prompting interest in pharmacological strategies. Vitamin C, owing to its antioxidant, vasomodulatory, and collagen synthesis–enhancing properties, may support dural healing and regulate cerebral vascular tone, thereby reducing PDPH risk. This prospective, randomised, double-blind, placebo-controlled study evaluated the effect of perioperative vitamin C supplementation on PDPH in 120 ASA I–II patients (18–60 years) undergoing elective lower abdominal or lower limb surgeries under spinal anesthesia. Participants were allocated into two groups: Group V received oral vitamin C (1 g preoperatively and 1 g 12 hours postoperatively), while Group P received placebo. Spinal anesthesia was administered using a 25G Quincke needle with 0.5% hyperbaric bupivacaine. The primary outcome was PDPH incidence within five postoperative days, while secondary outcomes included severity (VAS), onset time, duration, safety, and hemodynamic stability. Baseline characteristics were comparable between groups. The incidence of PDPH was significantly lower in the vitamin C group (10%) compared to the placebo group (21.7%) (p = 0.04). Severity was also reduced (VAS 3.2 ± 1.0 vs 4.6 ± 1.2; p < 0.01), and duration was shorter (2.4 ± 0.8 vs 3.5 ± 1.1 days; p = 0.03). However, the time of onset showed no significant difference (30 ± 5 vs 28 ± 6 hours; p = 0.22). No adverse effects were observed. In conclusion, perioperative vitamin C supplementation significantly reduces the incidence, severity, and duration of PDPH without affecting onset time, offering a safe, cost-effective, and practical adjunct for improving postoperative outcomes and patient comfort following spinal anesthesia.