Comparison between Adding Intravenous Neostigmine and Atropine versus Intravenous Hydrocortisone for Conservative Treatment of Postdural Puncture Headache after Spinal Anaesthesia for Elective Caesarean Section

Abstract

ost-dural puncture headache (PDPH) is a common adverse effect following spinal anesthesia. Various pharmacological and non-pharmacological methods are used for prevention and treatment of PDPH. Among these methods, epidural blood patch is considered the corner stone management of severe and prolonged form of PDPH but this invasive technique is not without possible serious complications which may aggravate the original problem. Pharmacological methods used for the prevention and the treatment of PDPH have variable effects on controlling this problem with a lot of conflicting results. Supportive treatments (such as hydration and bed rest), NSAIDs', caffeine, paracetamol, opioids, ACTH, dexamethasone, hydrocortisone, sumatriptan are used to control PDPH but with limited success. The introduction of the small gauge, a traumatic, and non-cutting spinal needles helped in lowering the incidence and severity of PDPH but the technique becomes increasingly difficult with the possibility of multiple dural punctures especially with lack of experience. Corticosteroids resolve PDPH and headache of intracranial hypotension. Patients with headache associated with spontaneous low CSF pressure, present a variable