The Effect of Intrathecal Fentanyl on Postdural Puncture Headache in Parturients Undergoing Cesarean Section: Prospective Double-Blinded Study

Purva  Gupta; Juhi  Saran; Vishwadeep Singh

Purva Gupta Senior resident, Department of Anaesthesiology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India.
Juhi Saran Professor, Department of Anaesthesiology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India.
Vishwadeep Singh Professor, Department of Anaesthesiology, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India.

Keywords: Intrathecal fentanyl, Post dural puncture headache, Cesarean section, Parturients, Spinal anesthesia, Doubleblinded study.

Abstract

Introduction: Post-dural puncture headache (PDPH) is one of
the most common side effects of spinal anesthesia, particularly
in parturients undergoing cesarean section. Intrathecal fentanyl,
often administered as an adjunct to local anaesthetic, has been
proposed as a potential mitigating agent for PDPH. However,
the evidence regarding its efficacy remains inconclusive. The
purpose of this study is to evaluate the effect of intrathecal
fentanyl on the incidence and severity of PDPH in parturients
undergoing cesarean section.
Material and Methods: About 124 patients were randomly
allocated using a simple randomization technique into 2
groups, with 62 patients in each group. Group A – 2.5 mL 0.5%
Bupivacaine + 0.5 mL NS, Group B –2.5 mL 0.5% Bupivacaine
+ 0.5 mL fentanyl (25 mcg). Categorical variables are presented
as absolute numbers and percentages. The software used for
the statistical analysis was SPSS v21.0 (IBM, USA).
Results: The parturient was monitored for post-dural puncture
headache PDPH during the post-operative period until
discharge. Patients were questioned about the onset, duration,
and severity of headache. Severity was evaluated using the
visual analogue scale. There was no significant difference in
the incidence of PDPH. There was a significant difference in
severity between the two groups. More hypotension was seen
in group A compare to group B.
Conclusion: We concluded that the women who were
impacted by the addition of IT fentanyl to bupivacaine for spinal
anesthesis (SA) in obstetric patients reported better postpartum
recovery and a reduction in the intensity and duration of their
headaches, improved hemodynamic stability, and lengthened
the period of post-operative analgesia. Further well-designed
RCTs with larger sample sizes are warranted to confirm these
findings and elucidate optimal dosing strategies for intrathecal
fentanyl in this population.

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