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Effect of dexamethasone on the incidence of post-dural puncture headache after spinal anesthesia: a randomized, double-blind, placebo-controlled trial and a meta-analysis.

Abstract
The effect of dexamethasone on post-dural puncture headache (PDPH) after spinal anesthesia has not been well elucidated. This randomized, double-blind, placebo-controlled trial was carried out in patients undergoing a cesarean at the Qilu Hospital, Shandong University. The subjects were randomly divided into a placebo and a dexamethasone group. The incidences of PDPH on the first, second, third and seventh postoperative day were studied, and the severity of PDPH was assessed using a visual analog scale. Studies in PubMed, Embase and the Cochrane Library database were searched and included in the present meta-analysis. Summary estimates of weighted mean differences and 95 % confidence intervals (CIs) were obtained using random-effects models. We included 307 participants in the dexamethasone group and 309 in the placebo group for analysis. The results indicated that prophylactic administration of 8 mg dexamethasone did not have any protective effect against PDPH (31 vs. 18, P = 0.054) and even increased the incidence of PDPH in the first 24 h in parturient patients (25 vs. 11, P = 0.016). Furthermore, the meta-analysis also showed that dexamethasone did not prevent the incidence of PDPH in the postoperative follow-up days (RR 1.05; 95 % CI 0.46-2.38; P = 0.91) and may even have increased the trend in the first 24 h. Prophylactic administration of 8 mg dexamethasone does not have any protective effect against PDPH and may even increase the incidence of PDPH in the first 24 h in patients with spinal anesthesia.
AuthorsBo Yang, Dong-Liang Li, Ping Dong, Xi-Yan Zhang, Li Zhang, Jin-Gui Yu
JournalActa neurologica Belgica (Acta Neurol Belg) Vol. 115 Issue 1 Pg. 59-67 (Mar 2015) ISSN: 2240-2993 [Electronic] Italy
PMID24865592 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Anti-Inflammatory Agents
  • Dexamethasone
Topics
  • Adult
  • Anesthesia, Spinal (adverse effects)
  • Anti-Inflammatory Agents (therapeutic use)
  • Databases, Factual (statistics & numerical data)
  • Dexamethasone (therapeutic use)
  • Double-Blind Method
  • Female
  • Humans
  • Incidence
  • Male
  • Meta-Analysis as Topic
  • Post-Dural Puncture Headache (drug therapy, epidemiology, etiology)
  • Visual Analog Scale
  • Young Adult

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