The Efficacy of Neostigmine as an adjuvant to Hyperbaric Prilocaine 2% for intrathecal Block in Reducing the Incidence and Severity of Post Dural Puncture Headache after Cesarean Section: a Randomized Controlled Clinical Trial

Abstract Background Post dural puncture headache (PDPH) presents following intentional or unintentional puncture of dura while performing neuraxial anesthesia and is a common cause of significant morbidity in the obstetric population. It can have significant impacts on new mothers’ ability to care for their newborns and often treatment is required to improve/alleviate symptoms. Obstetric patients are considered at increased risk for this condition because of their sex, young age, and the widespread use of neuraxial blocks. The aim of the study was to evaluate the efficacy and safety of intrathecal Neostigmine as an adjuvant to Prilocaine in reducing the incidence and severity of Post Dural Puncture Headache (PDPH) after Cesarean Section. Method One Hundred and Forty parturient were given spinal anesthesia for elective cesarean section. They were randomly divided into two equal groups. For Neostigmine Group (N) (n = 70) 20 mcg (diluted in 0.2 ml) of Neostigmine methyl sulphate was added to 3 ml of hyperbaric Prilocaine 2% and injected intrathecally. For Control Group (C) (n = 70), an equal volume of 0.2 ml of Dextrose 5% added to 3ml of hyperbaric Prilocaine 2% and injected intrathecally. Results Post dural puncture headache in Control Group occurred in Fifteen parturient (21.4%) compared to only Four parturient in Neostigmine Group (5.7%) (P = 0.007). Seven Parturient in Control group (10%) experienced Mild headache compared to Four parturient in Neostigmine group (5.7%) (P = 0.02), Six parturient in Control group (8.6%) experienced Moderate headache compared to No parturient in Neostigmine group (P = 0.02), Two parturient in Control group (2.9%) experienced Severe headache compared to No parturient in Neostigmine group (P = 0.02). Hypotension occurred in Nineteen parturient (27.1%) in Control group compared to Thirteen parturient in Neostigmine group (18.6%) (P = 0.227), Bradycardia occurred in Six parturient (8.6%) in Control group compared to Five parturient (7.1%) in Neostigmine group (P = 0.753), Postoperative nausea and vomiting occurred in Five parturient (7.1%) in Control group compared to Seven parturient (10%) in Neostigmine group (P = 0.546). Conclusion Adding 20 mcg Neostigmine to intrathecal Prilocaine significantly decreased incidence and severity of Post dual puncture headache in parturient undergoing elective cesarean section.