The Effect of Intravenous versus Intra Thecal Dexamethazone in Bupivacaine Spinal Anesthesia on Postdural Puncture Headache (PDPH)

Abstract

S pinal anesthesia is a popular method of anesthesia, used for many surgical operations, especially in lower abdominal and lower limb surgeries. However, the process of subarachnoid anesthesia may be associated with adverse effects. Post dural puncture headache (PDPH) is one of the most disturbing side effect of spinal anesthesia. It may be mild self-limited or severe distressing condition, affecting patient life style. Several studies have been conducted to determine the pathogenesis and possible causes of post dural puncture headache. However, till now, its pathophysiology is unclear. The main mechanism is thought to be continuous leakage of cerebrospinal fluid (CSF) via the dural puncture, leading to decreased CSF volume and pressure. But, the relationship between low CSF volume and pressure and PDPH is not yet clear. Another suggested mechanism is that low CSF volume activates adenosine receptors, leading to vasodilatation and headache. Once PDPH occurred, bed rest, good hydration and other conservative measures should be considered. If not effective, other measures are suggested, such as caffeine, or invasive trying to replace the CSF leakage (by epidural saline), or to close the dural puncture site (by epidural colloid or blood patch).