Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache: A Randomized Controlled Trial

  title={Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache: A Randomized Controlled Trial},
  author={Ahmed Abdelaal Ahmed Mahmoud and Amr Zaki Mansour and Hany Mahmoud Yassin and Hazem A. Hussein and Ahmed M Kamal and Mohamed Elayashy and Mohamed Farid Mohamed Elemady and Hany W. Elkady and Hatem Elmoutaz Mahmoud and Barbara Cusack and Hisham Hosny and Mohamed Mohamed Abdelhaq},
  journal={Anesthesia \& Analgesia},
BACKGROUND: Postdural puncture headache (PDPH) lacks a standard evidence-based treatment. [] Key Method Patients received either neostigmine 20 &mgr;g/kg and atropine 10 &mgr;g/kg or an equal volume of saline. RESULTS: Visual analog scale scores were significantly better (P< .001) with neostigmine/atropine than with saline treatment at all time intervals after intervention. No patients in the neostigmine/atropine group needed epidural blood patch compared with 7 (15.9%) in the placebo group (P< .001…

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EBP was superior to ITC and neostigmine in reducing the incidence of PDPH and pain severity with less complications and was significantly higher in the control group than other groups.
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REFERENCES 1. Jerath A, Yang QJ, Pang KS, et al. Tranexamic acid dosing for cardiac surgical patients with chronic renal dysfunction: a new dosing regimen. Anesth Analg. 2018;127:1323–1332. 2. Yang
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In Response.
Post-dural puncture headache.
The therapeutic epidural blood patch is the only treatment for which there is enough evidence to recommend its routine use for severe cases of post-dural puncture headache, and Larger multicenter trials are needed to back up alternative treatment strategies.
In Response.
The present study involved parturients who developed postdural puncture headache after a spinal anesthetic and the authors described possible vasoconstriction mediated by neostigmine and an anticholinergic agent, now more frequently glycopyrrolate than atropine.
Facing postdural puncture headache in COVID-19 times
The recent report by Levin and Cohen describing safe, simple and inexpensive methods to administer the sphenopalatine ganglion block (SGB) shows a faster relief by SGB and fewer complications than epidural blood.
Response to comments by Dr Forero to our daring discourse
It is still do not believe that the test of time will show that the ESPB will merit to be included among the aforementioned wellestablished blocks in the context of anterior surgery on the chest or abdomen but instead will share the fate of the interpleural nerve block.


Postdural puncture headache
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    Korean journal of anesthesiology
  • 2017
Conservative therapies such as bed rest, hydration, and caffeine are commonly used as prophylaxis and treatment for this condition; however, no substantial evidence supports routine bed rest and aggressive hydration.
[Postdural puncture headache].
PDPH are not the privilege of spinal anaesthesia, as they can occur in various circumstances including epidural anesthesia, surgical wound of the dura, spinal tap and/or myclography. Diagnosis PDPH
Sphenopalatine ganglion block for postdural puncture headache
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Migraine: its treatment with prostigmine bromide.
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  • Medicine
    Canadian Medical Association journal
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This combination of ether and ether permits use of the two agents without fear of giving a toxic overdose of either, and is an advance in anawsthesia.
Central anticholinergic syndrome (CAS) in anesthesia and intensive care.
The central cholinergic blockade, known as the central anticholinergic syndrome (CAS), is identical with the central symptoms of atropine intoxication and may considerably impair the postanesthetic period especially when agitation is prevalent, which may endanger the patient or the surgical results.
A ganglion stimulating action of neostigmine.
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    British journal of pharmacology and chemotherapy
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Results from the nictitating membrane preparation in the anaesthetized cat are consistent with the view that neostigmine exerts a direct stimulant action on the ganglion, which is distinct from its anticholinesterase action.