The outcomes of a novel double-blind placebo-controlled trial determined that the use of prophylactic dexamethasone decreases the occurrence and severity of post-dural puncture headache (PDPH) on both the first and fourth day of the surgery following spinal anaesthesia for cesarean section (CS). Dexamethasone also improved the occurrence of nausea.

In this double-blind placebo-controlled randomized trial, Boniface Chukwuneme Okpala and colleagues evaluated the efficacy of dexamethasone in decreasing the PDPH following spinal anaesthesia for CS.

Overall, 192 parturients undergoing CS under spinal anaesthesia were either given dexamethasone 2ml (8 mg) (96 parturients) intravenously (IV) or normal saline 2ml (96 parturients) IV as placebo. The occurrence and severity of PDPH on the first and fourth days of the surgery were assessed via the visual analogue scale. PDPH occurrence was regarded as the primary outcome. Nausea and vomiting occurrence was a secondary outcome.

Similar baseline, socio-demographic and clinical variables were observed in both the study groups, dexamethasone and placebo group. No female lost to the follow-up. As found, in the dexamethasone group, the occurrence of PDPH and nausea were considerably lower, as shown in the following table 1:

Table 1: Comparison of complication in Dexamethasone and Placebo group.

Also, headache severity in the control groups was statistically higher on the first and fourth days following the surgery.

Thus, on the first and fourth postoperative day following spinal anesthesia for CS, the prophylactic administration of dexamethasone minimizes PDPH occurrence and severity. Compared to control, an improvement in the nausea incidence was witnessed in the dexamethasone group.