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Nebulized dexmedetomidine (DEX) is effective to treat post-dural
puncture headache (PDPH) in parturients undergoing elective cesarean section.
A randomized prospective double-blind controlled trial published in the "Journal of anesthesia" revealed that adding DEX nebulization to the PDPH conservative management minimizes pain and improves the symptoms in parturients who are undergoing elective cesarean section under spinal anesthesia. This may be due to its cerebral vasoconstrictive and analgesic effects.
Investigators carried out the trial to determine the efficacy of adding DEX (1 µg/kg twice daily) to PDPH conservative care and assess its cerebral hemodynamic effects trans-cranial Doppler in 43 post-partum PDPH females having Lybecker score ≥ 2 and visual analog score (VAS) ≥ 4.
Participants were assigned into two groups: (i) Control group (n = 22): Given nebulization of 4 mL 0.9% saline, and (ii) DEX group (n = 21): Given nebulization of 1 µg/kg DEX diluted in 4 mL 0.9% saline twice daily. The procedure was continued until attaining VAS score ≤ 3 and Lybecker score < 2 and/or for a max of 72 hours.
Both the arms were given routine conservative management. The major endpoint was Lybecker and VAS scores while the secondary endpoints were the effects of DEX on cerebral vessels and the incidence of side effects.
When compared with the control group, the DEX group demonstrated reduced scores (VAS and Lybecker), minimized middle cerebral artery mean flow velocity, and raised pulsatility index after DEX nebulization. Notably, 2 participants in the control arm were indicated for an epidural blood patch.
Thus, it was concluded that adding
DEX nebulization is effective to improve the symptoms and lower pain scores in
post-partum females suffering from PDPH.
Journal of anesthesia
Effectiveness of nebulized dexmedetomidine for treatment of post-dural puncture headache in parturients undergoing elective cesarean section under spinal anesthesia: a randomized controlled study
Sherif M S Mowafy et al.
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