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

Abstract

Introduction: Post-dural puncture headache (PDPH) is one ofthe most common side effects of spinal anesthesia, particularlyin parturients undergoing cesarean section. Intrathecal fentanyl,often administered as an adjunct to local anaesthetic, has beenproposed as a potential mitigating agent for PDPH. However,the evidence regarding its efficacy remains inconclusive. Thepurpose of this study is to evaluate the effect of intrathecalfentanyl on the incidence and severity of PDPH in parturientsundergoing cesarean section.Material and Methods: About 124 patients were randomlyallocated using a simple randomization technique into 2groups, 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 presentedas absolute numbers and percentages. The software used forthe statistical analysis was SPSS v21.0 (IBM, USA).Results: The parturient was monitored for post-dural punctureheadache PDPH during the post-operative period untildischarge. Patients were questioned about the onset, duration,and severity of headache. Severity was evaluated using thevisual analogue scale. There was no significant difference inthe incidence of PDPH. There was a significant difference inseverity between the two groups. More hypotension was seenin group A compare to group B.Conclusion: We concluded that the women who wereimpacted by the addition of IT fentanyl to bupivacaine for spinalanesthesis (SA) in obstetric patients reported better postpartumrecovery and a reduction in the intensity and duration of theirheadaches, improved hemodynamic stability, and lengthenedthe period of post-operative analgesia. Further well-designedRCTs with larger sample sizes are warranted to confirm thesefindings and elucidate optimal dosing strategies for intrathecalfentanyl in this population.