title: Effect of dexamethasone on the incidence of post-dural puncture headache after spinal anesthesia: a randomized, double-blind, placebo-controlled trial and a meta-analysis.
abstract: The effect of dexamethasone on post-dural puncture headache (PDPH) after spinal anesthesia has not been well elucidated. This randomized, double-blind, placebo-controlled trial was carried out in patients undergoing a cesarean at the Qilu Hospital, Shandong University. The subjects were randomly divided into a placebo and a dexamethasone group. The incidences of PDPH on the first, second, third and seventh postoperative day were studied, and the severity of PDPH was assessed using a visual analog scale. Studies in PubMed, Embase and the Cochrane Library database were searched and included in the present meta-analysis. Summary estimates of weighted mean differences and 95 % confidence intervals (CIs) were obtained using random-effects models. We included 307 participants in the dexamethasone group and 309 in the placebo group for analysis. The results indicated that prophylactic administration of 8 mg dexamethasone did not have any protective effect against PDPH (31 vs. 18, P = 0.054) and even increased the incidence of PDPH in the first 24 h in parturient patients (25 vs. 11, P = 0.016). Furthermore, the meta-analysis also showed that dexamethasone did not prevent the incidence of PDPH in the postoperative follow-up days (RR 1.05; 95 % CI 0.46-2.38; P = 0.91) and may even have increased the trend in the first 24 h. Prophylactic administration of 8 mg dexamethasone does not have any protective effect against PDPH and may even increase the incidence of PDPH in the first 24 h in patients with spinal anesthesia.
authors.affiliation: Department of Anesthesiology, Qilu Hospital, Shandong University, 107# Wenhua Road, Jinan, 250012, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Yang
authors.forename: Dong-Liang
authors.initials: DL
authors.lastname: Li
authors.forename: Ping
authors.initials: P
authors.lastname: Dong
authors.forename: Xi-Yan
authors.initials: XY
authors.lastname: Zhang
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.forename: Jin-Gui
authors.initials: JG
authors.lastname: Yu
mesh_terms: D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D016208:Databases, Factual / Q000706:statistics & numerical data; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015201:Meta-Analysis as Topic; D051299:Post-Dural Puncture Headache / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D064232:Visual Analog Scale; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone