Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache: A Randomized Controlled Trial

Anesthesia and Analgesia
Ahmed Abdelaal Ahmed MahmoudMohamed Abdelhaq

Abstract

Postdural puncture headache (PDPH) lacks a standard evidence-based treatment. A patient treated with neostigmine for severe PDPH prompted this study. This randomized, controlled, double-blind study compared neostigmine and atropine (n = 41) versus a saline placebo (n = 44) for treating PDPH in addition to conservative management of 85 patients with hydration and analgesics. The primary outcome was a visual analog scale score of ≤3 at 6, 12, 24, 36, 48, and 72 hours after intervention. Secondary outcomes were the need for an epidural blood patch, neck stiffness, nausea, and vomiting. Patients received either neostigmine 20 μg/kg and atropine 10 μg/kg or an equal volume of saline. Visual analog scale scores were significantly better (P< .001) with neostigmine/atropine than with saline treatment at all time intervals after intervention. No patients in the neostigmine/atropine group needed epidural blood patch compared with 7 (15.9%) in the placebo group (P< .001). Patients required no >2 doses of neostigmine/atropine. There were no between-group differences in neck stiffness, nausea, or vomiting. Complications including abdominal cramps, muscle twitches, and urinary bladder hyperactivity occurred only in the neostigmine/atropine g...Continue Reading

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Citations

Jan 10, 2019·Minerva anestesiologica·Bigna S BuddebergThierry Girard
Apr 12, 2019·Anesthesia and Analgesia·Abhijit Sukumaran Nair
Apr 12, 2019·Anesthesia and Analgesia·Ahmed Abdelaal Ahmed Mahmoud
Mar 30, 2019·Anesthesia and Analgesia·Ahmed Abdelaal Ahmed Mahmoud
May 17, 2019·Anesthesia and Analgesia·Ahmed Abdelaal Ahmed Mahmoud
May 17, 2019·Anesthesia and Analgesia·Ahmed Abdelaal Ahmed Mahmoud
May 17, 2019·Anesthesia and Analgesia·Abhijit Sukumaran Nair
Oct 29, 2020·Regional Anesthesia and Pain Medicine·Andrés Rocha-RomeroGabriel Carvajal

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