Evaluation of prophylactic intravenous hydrocortisone for the prevention of postdural puncture headache following spinal anesthesia for cesarean section

Context: Postdural puncture headache (PDPH) is a common complication following spinal anesthesia. No medication is currently used on routine basis for its prevention despite its high incidence. Aims: This study evaluated the efficacy of prophylactic intravenous (IV) hydrocortisone 100 mg in reducing the incidence and severity of PDPH among obstetric patients who had spinal anesthesia for cesarean delivery. Study Design: This study is a double-blind, randomized controlled trial in which 400 consenting parturients having cesarean section under spinal anesthesia were randomized into two groups; hydrocortisone and control groups. Following delivery, patients in the hydrocortisone group received IV hydrocortisone 100 mg diluted to 2 ml while those in the control group received the same volume of 0.9% saline. Patients were reviewed for the occurrence of PDPH over 5 days and headache severity assessed using the numerical rating scale. Intraoperative and postoperative side effects of single-dose hydrocortisone were also documented. Statistical Analysis: Data were analyzed using SPSS 20 software. A P < 0.05 was considered statistically significant. Results: A total of 197 and 194 patients completed the study in the hydrocortisone and control groups, respectively. In the hydrocortisone group, 46 patients (23.4%) developed PDPH compared to 48 patients (24.7%) in the control group (P = 0.813). Both the mean maximum NRS scores as well as headache severity grades were similar between both groups with P = 0.930 and 0.714, respectively. The duration of PDPH averaged 2.87 <plus/minus> 1.44 days in hydrocortisone group compared with 2.73 +/- 1.38 days in control group (P = 0.630). Conclusions: Prophylactic IV hydrocortisone 100 mg does not reduce the incidence or severity of PDPH following spinal anesthesia for cesarean section.