A COMPARATIVE STUDY BETWEEN THE EFFECT OF AMINOPHYLLINE, NEOSTIGMINE AND GABAPENTIN ON PREVENTION OF POST DURAL PUNCTURE HEADACHE AFTER CESAREAN SECTION, (blind, randomized study)

Abstract

PDPH is the most common complication after SA. The postulated cause of the headache is loss of CSF in the epidural space through the dural puncture site which leads to decrease in CSF pressure. A second possible cause is the sudden decrease in CSF pressure which leads to vasodilation of the intracranial vessels (to maintain a constant intracranial volume),which resembles the pathophysiology of vascular headache. 90% of PDPHs occur within 3 days of the procedure and 66% start in the first 48 h Finally, the headache should resolve spontaneously within 1 w or within 48 h of receiving effective treatment of the CSF leak usually by EBP. Current treatment for PDPH involves complete bed rest, hydration, analgesics, oral or intravenous caffeine, sumatriptan, ACTH, corticosteroids, and EBP. The aim of this study was to compare between the prophylactic effect of each of aminophylline, gabapentin, and neostigmine on the occurrence of PDPH.

Aminophylline mechanism underlying the treatment effects in PDPH remains unclear. The mechanism could be related to specific factors. Firstly, it could block adenosine, contract intracranial blood vessels and block the transmission of pain through noci-receptors. Secondly, it could inhibit phosphodiesterase and raise the intracellular cAMP concentration. Thirdly, it could suppress the Ca uptake by the endoplasmic reticulum in endothelial cells, stimulate Ca-K pumps, and increase the secretion of CSF. As regards neostigmine, it was found to have an initial direct stimulatory action on depolarization of cerebrospinal ganglia leading to cerebral vasoconstriction which antagonizes the cerebral vasodilation occurring with PDPH and explains the fast improvement of headache.