مقايسه تاثير تجويز آمينوفيلين، پاراستامول، تركيب آمينوفيلين و پاراستامول بر پيشگيري از سردرد پس از بي‌حسي اسپاينال در جراحي اندام تحتاني

The efficacy of prophylactic intravenous aminophylline, paracetamol or aminophylline and paracetamol in prevention of post spinal headache in lower extremity surgeries compared to the control group

زمينه و هدف: سردرد يكي از مشكلات شايع پس از بي‌حسي نخاعي در بلوك‌هاي نوروآگزيال است. رژيم‌هاي دارويي مختلفي براي درمان پيشنهاد شده است. اين مطالعه به بررسي تاثير آمينوفيلين، پاراستامول و تجويز همزمان اين دو دارو بر پيشگيري از سردرد پس از بي‌حسي اسپاينال پرداخت. روش بررسي: در يك مطالعه كارآزمايي باليني دوسوكور، به ارزيابي 120 بيمار در 4 گروه 30 نفره كه جهت جراحي اندام تحتاني به بيمارستان‌هاي الزهرا (س) و كاشاني اصفهان در سال‌هاي 1395 و 1396 مراجعه كرده و تحت بي‌حسي نخاعي قرار گرفته بودند، پرداختيم. در گروه آمينوفيلين، پاراستامول، آمينوفيلين-پاراستامول و شاهد به‌ترتيب، آمينوفيلين (mg/kg 1/5) به‌صورت آهسته، پاراستامول (mg 1000)، آمينوفيلين و پاراستامول با دوز مشابه، نرمال سالين، همگي به‌صورت داخل وريدي تزريق گرديد. بروز سردرد پيش از بي‌حسي اسپاينال، 15 دقيقه پيش از خروج ريكاوري، روز اول هر 6 ساعت و هفته اول روزانه در 4 گروه مورد ارزيابي قرار گرفت. يافته‌ها: 42 بيمار (35%) از بيماران مورد مطالعه، 40% از بيماراني كه آمينوفيلين دريافت كردند، 33/3% از بيماراني كه پاراستامول دريافت كردند، 20% از بيماراني كه پاراستامول و آمينوفيلين را با هم دريافت كردند و 6/46% از گروه شاهد (نرمال سالين) دچار سردرد شدند (0/05P=). فراواني تهوع در هيچ‌كدام از زمان‌ها بين 4 گروه تفاوت معنادار نداشت. نتيجه‌گيري: اين مطالعه نشان داد كه تجويز همزمان آمينوفيلين و پاراستامول به‌صورت داخل وريدي، موجب كاهش معناداري در سردرد پس از بي‌حسي نخاعي در جراحي اندام تحتاني مي‌شود.

Background: Post-dural puncture headache (PDPH) is commonly seen after neuraxial block and it usually lasts for up to two days or in some cases for up to two weeks. Several types of regimens have been suggested for treatment, such as theophylline and caffeine. This study aimed to evaluate the effects of aminophylline, paracetamol, and administration of aminophylline and paracetamol concurrently on prevention of PDPH. Methods: In a double-blind randomized clinical trial, we evaluated 120 patients in four groups (n=30) undergoing spinal anesthesia for extremity surgery in educational hospitals of Isfahan University of Medical Sciences (Alzahra and Ayatollah Kashani Hospitals), Iran, from 2016 to 2017. In group A aminophylline was injected slowly intravenously (1.5 mg/kg), in group B paracetamol (1000 mg) was injected intravenously, in group C aminophylline and paracetamol was injected with the same dose and in control group (n=30) normal saline was injected intravenously. After patients entered the operating room, mean arterial blood pressure and heart rate were measured and oxygen saturation was monitored. Before spinal anesthesia, 15 minutes before leaving the recovery room, every 6 hours in first day and daily in first week after the surgery, incidence of PDPH in each group were evaluated. The frequency of nausea between the four groups was also studied. Results: 42 patients (35%) out of the 120 ones suffered from headache. 40% of patients who had received aminophylline, 33.3% of patients who had received paracetamol, 20% of patients who had received aminophylline and paracetamol and 46.6% of patients who had not received any drug suffered from headache (P=0.05). The frequency of nausea was not significantly different between the four groups at any time. The average of heart rate, mean arterial pressure and oxygen saturation in recovery and 24 hours after operation were not significantly different between the four groups. Conclusion: This study shows that intravenous administration of aminophylline and paracetamol significantly reduces the incidence of post-dural puncture headache (PDHP) in lower extremity surgery and we can use this regimen for prevention.