Role of Cosyntropin in the Prevention of Postdural Puncture Headache: A Propensity-matched Retrospective Analysis

( Int J Obstet Anesth . 2023;56:103922. doi: 10.1016/j.ijoa.2023.103922) Postdural puncture headache (PDPH) frequently follows unintended dural puncture during epidural placement in obstetric patients, affecting up to 85% of cases and significantly impacting maternal well-being. PDPH can lead to prolonged hospital stays and even chronic headaches. Preventive measures like bed rest and hydration have shown limited efficacy, while medications like adrenocorticotropic hormone and cosyntropin offer potential relief, albeit with inconclusive evidence. Prophylactic use of cosyntropin has shown promise in reducing PDPH incidence and severity, possibly by enhancing analgesia and increasing cerebrospinal fluid production. However, this finding lacks replication in other trials, and widespread recommendation is lacking due to methodological limitations. Conducting randomized controlled trials in this context is challenging. This study retrospectively investigated the effectiveness of prophylactic cosyntropin in reducing PDPH incidence and severity in obstetric patients, aiming to address the gap in evidence regarding its use.