Drug therapy for preventing post-dural puncture headache

Post-dural (post-lumbar or post-spinal) puncture headache (PDPH) is one of the most common complications of diagnostic, therapeutic or inadvertent lumbar punctures. Many drug options have been used to prevent headache in clinical practice and have also been tested in some clinical studies, but there...

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Published in:Cochrane database of systematic reviews 2013-02, Vol.2013 (2), p.CD001792
Main Authors: Basurto Ona, Xavier, Uriona Tuma, Sonia Maria, Martínez García, Laura, Solà, Ivan, Bonfill Cosp, Xavier
Format: Article
Language:English
Subjects:
Adult
Aminophylline - administration & dosage
Analgesics - administration & dosage
Caffeine - administration & dosage
Child
Child health
Cosyntropin - administration & dosage
Dexamethasone - administration & dosage
Dexamethasone - adverse effects
Drug Administration Routes
Female
Fentanyl - administration & dosage
Headache and migraine
Humans
Indomethacin - administration & dosage
Male
Morphine - administration & dosage
Morphine - adverse effects
Neurology
Post-Dural Puncture Headache - prevention & control
Randomized Controlled Trials as Topic
Spinal Puncture - adverse effects
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Summary:Post-dural (post-lumbar or post-spinal) puncture headache (PDPH) is one of the most common complications of diagnostic, therapeutic or inadvertent lumbar punctures. Many drug options have been used to prevent headache in clinical practice and have also been tested in some clinical studies, but there are still some uncertainties about their clinical effectiveness. To assess the effectiveness and safety of drugs for preventing PDPH in adults and children. The search strategy included the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2012, Issue 5), MEDLINE (from 1950 to May 2012), EMBASE (from 1980 to May 2012) and CINAHL (from 1982 to June 2012). There was no language restriction. We considered randomised controlled trials (RCTs) that assessed the effectiveness of any drug used for preventing PDPH. Review authors independently selected studies, assessed risks of bias and extracted data. We estimated risk ratios (RR) for dichotomous data and mean differences (MD) for continuous outcomes. We calculated a 95% confidence interval (CI) for each RR and MD. We did not undertake meta-analysis because participants' characteristics or assessed doses of drugs were too different in the included studies. We performed an intention-to-treat (ITT) analysis. We included 10 RCTs (1611 participants) in this review with a majority of women (72%), mostly parturients (women in labour) (913), after a lumbar puncture for regional anaesthesia. Drugs assessed were epidural and spinal morphine, spinal fentanyl, oral caffeine, rectal indomethacin, intravenous cosyntropin, intravenous aminophylline and intravenous dexamethasone.All the included RCTs reported data on the primary outcome, i.e. the number of participants affected by PDPH of any severity after a lumbar puncture. Epidural morphine and intravenous cosyntropin reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to placebo. Also, intravenous aminophylline reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to no intervention, while intravenous dexamethasone increased it. Spinal morphine increased the number of participants affected by pruritus when compared to placebo, and epidural morphine increased the number of participants affected by nausea and vomiting when compared to placebo. Oral caffeine increased the number of participants affected by insomnia when compared to placebo.The remain
ISSN:1469-493X
DOI:10.1002/14651858.CD001792.pub3