Prophylactic administration of aminophylline plus dexamethasone reduces post-dural puncture headache better than using either drug alone in patients undergoing lower extremity surgery

BACKGROUND: Post-dural puncture headache (PDPH) is a known complication of neuroaxial anesthesia and may be associated with significant morbidity. As invasive treatment for PDPH has known complications, pharmacologic management may be preferable. The main objective of the present study was to evaluate the effects of combining administration of intravenous aminophylline and dexamethasone on PDPH in patients who underwent lower extremity surgery in comparison with using either drug alone and also comparing them with placebo. MATERIALS AND METHODS: One hundred and forty patients, aged 20-65 years, scheduled for lower extremity surgery in Alzahra University Hospital under spinal anesthesia were enrolled in this randomized, double-blind, placebo-controlled study. Patients were divided into four groups of 35 each and received aminophylline 1.5 mg/kg i.v. (group A), dexamethasone 0.1 mg/kg (group D), aminophylline 1.5 mg/kg plus dexamethasone 0.1 mg/kg i.v. (group AD), and placebo (group P). The incidences of PDPH and complete response were evaluated at 6-48 h after arrival to the ward in the four groups. RESULTS: Patients in group AD had significantly lower incidence of PDPH (5.88% vs. 20.58% for group A and 17.14% for group D with P < 0.05), the highest incidence of complete response, and also, less analgesic requirement compared with groups A, D, and P throughout 6-48 h (1.2 ± 0.4 vs. 2.3 ± 0.75 for group A, 1.8 ± 0.6 for group D, and 3.3 ± 1 for placebo group with P < 0.05). CONCLUSION: Combine administration of aminophylline 1.5 mg/kg plus dexamethasone 0.1 mg/kg significantly reduced PDPH better than using either drug alone in patients who underwent lower extremity surgery under spinal anesthesia.