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

@article{AbdelaalAhmedMahmoud2018AdditionON,
  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},
  year={2018},
  volume={127},
  pages={1434–1439}
}
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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Questions Regarding the Use of Neostigmine-Atropine to Treat Postdural Puncture Headache.
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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.
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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.
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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.
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