title: Effect of venous dexamethasone, oral caffeine and acetaminophen on relative frequency and intensity of postdural puncture headache after spinal anesthesia.
abstract: BACKGROUND
  Postdural puncture headache (PDPH) is a relatively common complication after regional anesthesia, especially in younger people, bothersome to patients and needs prophylaxis to prevent this complication. This study was conducted aiming to determine the preventive effect of dexamethasone plus caffeine and acetaminophen on relative frequency and intensity of PDPH after spinal anesthesia.
  
  
  METHODS
  In a clinical trial study, 90 candidates for the lower extremities orthopedic elective operation were divided into two groups of 45 individuals each. Intervention group received the compound of 500 mg acetaminophen +65 mg oral caffeine +8 mg venous dexamethasone an hour before spinal blocking, and the control group received placebo tablets + a dexamethasone equivalent volume of venous normal saline. The level of postoperative headache at the time of entrance to recovery and discharge, 6, 12, 24, 48, and 72 h postoperatively were measured based on Visual Analog Scale criterion in the two groups and then compared with each other.
  
  
  RESULTS
  During the study, 24 patients in the control group and 17 patients in the intervention group were afflicted with headache; however, with no significant difference (P = 0.14). Total frequency of headache incidence was 35 times in the control group and 27 times in the intervention group (P = 0.32).
  
  
  CONCLUSIONS
  Though the taking of acetaminophen + caffeine + dexamethasone is associated with a decrease in headache intensity and duration and decrease in PDPH incidence, compared with placebo, however, no essentially and statistically significant effect was produced.
authors.affiliation: Department of Anesthesiology and Critical Care, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Masoudifar
authors.affiliation: Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Omid
authors.initials: O
authors.lastname: Aghadavoudi
authors.affiliation: Department of Anesthesiology and Critical Care, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Sajjad
authors.initials: S
authors.lastname: Adib
keywords: Acetaminophen; caffeine; dexamethasone; headache; postdural puncture