Comparing the prophylactic effect of ondansetron and dexamethasone in controlling headaches caused by spinal anesthesia among women candidated for caesarean A randomized controlled trial
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Department of Gynecology, Arak University of Medical Sciences, Arak, Iran
Department of Anesthesiology, Arak University of Medical Sciences, Arak Iran
Publication date: 2018-07-10
Electron J Gen Med 2018;15(4):em64
Spinal anesthesia is one of the most popular methods of anesthesia for caesarean. One of the major side effects of this method is the headache that the patients would experience as a result of spinal anesthesia. Ondansetron and dexamethasone have been reported to be very useful in reducing these headaches. The present research seeks to study the effects of these two types of medicine in reducing the headaches caused by spinal anesthesia among women candidated for caesarean.

Materials and Methods:
This is a double-blind clinical trial conducted on 120 mothers candidated for elective, second time caesarean. They were divided into the following groups with 40 participants in each one: dexamethasone, ondansetron, and placebo. 8 milligram of IV dexamethasone was used for the first group, while the second group was given 8 milligram of IV ondansetron, and the third group was given the same amount of IV distilled water. After the operation, patients’ pain scores were measured at 12, 24, and 48 hours following the operation and the average amount of painkiller used 24 hours after the operation was recorded. SPSS 19 was used to analyze the data.

A significant difference was observed between the three groups in terms of the frequency of post-spinal anesthesia headache. This frequency was significantly higher in placebo group compared to what was observed in the other two groups (P = 0.01).

Finally, it turned out that both dexamethasone and ondansetron are very effective in reducing headaches caused by spinal anesthesia. Statistics show that dexamethasone is much better and more effective than ondansetron.

Martin TC, Bell P, Ogunbiyi O. Comparison of general anaesthesia and spinal anaesthesia for caesarean section in Antigua and Barbuda. West Indian Med J. 2007;56(4):330-3.
Fattahi Z, Hadavi SM, Sahmeddini MA. Effect of ondansetron on post-dural puncture headache (PDPH) in parturients undergoing cesarean section: a double-blind randomized placebo-controlled study. Journal of anesthesia. 2015;29(5):702-7. https://doi.org/10.1007/s00540....
Siddiqui AS, Salim B, Hashemy N, Siddiqui SZ. Post-dural Puncture Headache After Spinal Anaesthesia for Caesarean Section. Journal of Surgery Pakistan (International). 2015;20:1.
Tavakol K, Ghaffari P, Hassanzadeh A. Study of the effect of dexamethasone and normal saline in reducing headache after spinal anesthesia in cesarean section. Armaghanedanesh. 2007;12(3):87-94.
Shahraki AD, Feizi A, Jabalameli M, Nouri S. The effect of intravenous Dexamethasone on post-cesarean section pain and vital signs: A double-blind randomized clinical trial. Journal of research in pharmacy practice. 2013;2(3):99. https://doi.org/10.4103/2279-0....
Hamzei A, Basiri-Moghadam M, Pasban-Noghabi S. Effect of dexamethasone on incidence of headache after spinal anesthesia in cesarean section. A single blind randomized controlled trial. Saudi medical journal. 2012;33(9):948-53.
Pasban-Noghabi S, Ekrami-Noghabi A, Kamran H. Can dexamethasone reduce postdural puncture headache?. AANA journal. 2014;82(1):7.
Naghibi K, Hamidi M. Prophylactic administration of aminophylline plus dexamethasone reduces post-dural puncture headache better than using either drug alone in patients undergoing lower extremity surgery. Adv Biomed Res. 2014;3:5. https://doi.org/10.4103/2277-9....
Yousefshahi F, Dahmardeh AR, Khajavi M, Najafi A, Khashayar P, Barkhordari K. Effect of dexamethasone on the frequency of postdural puncture headache after spinal anesthesia for cesarean section: a double-blind randomized clinical trial. Acta Neurologica Belgica. 2012;112(4):345-50. https://doi.org/10.1007/s13760....
Sane S, Hasanlui MV, Abbasivash R, Mahoori A, Hashemi ST, Rafiei F. Comparing the effect of intravenous dexamethasone, intravenous ondansetron, and their combination on nausea and vomiting in cesarean section with spinal anesthesia. Advanced biomedical research. 2015;4:230. https://doi.org/10.4103/2277-9....
Kalani N, Zabetian H, Sanie MS, Deylami M, Radmehr M, Sahraei R, Jahromi HK, Kooti W. The Effect of Ondansetron and Dexamethasone on Nausea and Vomiting under Spinal Anesthesia. World journal of plastic surgery. 2017;6(1):88.
Doroudian MR, Norouzi M, Esmailie M, Tanhaeivash R. Dexamethasone in preventing post-dural puncture headache: a randomized, double-blind, placebo-controlled trial. ActaAnaesthesiologicaBelgica. 2011;62(3):143-6.
Zhou C, Zhu Y, Bao Z, Wang X, Liu Q. Efficacy of ondansetron for spinal anesthesia during cesarean section: a meta-analysis of randomized trials. J Int Med Res. 2017 Jan 1:300060517716502. doi: 10.1177/0300060517716502. [Epub ahead of print]. https://doi.org/10.1177/030006....
American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol. 2014;123(3):693-711. https://doi.org/10.1097/01.AOG....
Diaz JH. Epidemiology and outcome of postural headache management in spontaneous intracranial hypotension. Reg Anesth Pain Med. 2001;26(6):582-587. https://doi.org/10.1097/001155....
Carp H, Singh PJ, Vadhera R, Jayaram A. Effects of the serotonin-receptor agonist sumatriptan on post-dural puncture headache: report of six cases. AnesthAnalg. 1994;79(1):180–182. https://doi.org/10.1213/000005....
Yazigi A, Chalhoub V, Madi-Jebara S, Haddad F, Hayek G. Prophylactic ondansetron is effective in the treatment of nausea and vomiting but not on pruritus after cesarean delivery with intrathecalsufentanil-morphine. Journal of clinical anesthesia. 2002;14(3):183-6. https://doi.org/10.1016/S0952-....
Hatfalvi BI. Postulated Mechanisms for Postdural Puncture Headache and Review of Laboratory Models: Clinical Experience. Regional Anesthesia and Pain Medicine. 1995;20(4):329-36.
Evans RW, Armon C, Frohman EM, Goodin DS. Assessment: Prevention of post–lumbar puncture headaches Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2000;55(7):909-14. https://doi.org/10.1212/WNL.55....
Ye JH, Ponnudurai R, Schaefer R. Ondansetron: A Selective 5‐HT3 Receptor Antagonist and Its Applications in CNS‐Related Disorders. CNS drug reviews. 2001;7(2):199-213. https://doi.org/10.1111/j.1527....
Fujii Y, Nakayama M. Efficacy of dexamethasone for reducing postoperative nausea and vomiting and analgesic requirements after thyroidectomy. Otolaryngology Head and Neck Surgery. 2007;136(2):274-7. https://doi.org/10.1016/j.otoh....
Ghai A, Wadhera R. Adrenocorticotrophic hormone–is a single dose sufficient for post‐dural puncture headache? Acta Anaesthesiol Scand. 2007;51(2):266. https://doi.org/10.1111/j.1399....
Yousefian M, Ghafari M. Comparison Review of The effects of dexamethasone and ondansetron intravenous on preventing headache after spinal sedation of patients under a cesarean section in the alavi Hospital 2016-2017, International journal of scientific study. 2017;5(3):371-374.
Pazuki SH, Kamali A, Shahrokhi N. Comparison of effect of interatechal midazolam and tramadol with the conventional method of postoperative pain and shevering control after elective ceasarean section. Biomedical and Pharmacology Journal. 2016;9(3):995-1003. https://doi.org/10.13005/bpj/1....