The effect of aminophylline on prevention of post-spinal anesthesia headache in patients undergoing elective cesarean section: a randomized clinical trial

Background: The post-dural puncture headache (PDPH) is a common complication in spinal anesthesia. Headache may occure seven days after dural puncture. The headache may be worsened in sitting position and be better in supine position. PDPH is common in younger and tall people. The incidence rate of PDPH related to the size of spinal needle and the number of try and decrease with small, cutting needle and less puncture try. PDPH is a well-known iatrogenic complication of spinal anesthesia, which continues to be a major problem. In this study, we assessed the effect of intravenous aminophylline on prevention of post-spinal anesthesia headache in who were elective for cesarean sections. Methods: This double-blind randomized clinical trial was conducted on 140 women with 18 to 35 years old and American Society of Anesthesiologists Classification (ASA Class) I and II undergoing spinal anesthesia in elective cesarean section. Patients were randomly divided into two groups called case and control. After umbilical cord clamping 1 mg/kg aminophylline dissolved in 100 cc normal saline was infused to the case group but only 100 cc normal saline was infused for the control group. Patient's blood pressure and heart rate were recorded before spinal anesthesia, immediately after spinal anesthesia, after uterine incision and umbilical cord clamping, after drug injection and then every five minutes. The incidence of headache was assessed at 4, 8, 24, 48 and 72 hours after the surgery. Results: Although severity and duration of headache in case group was more than in control group, no meaningful difference was found between two groups. The mean changes in systolic blood pressure were greater in control group (P<0.001). The mean changes in heart rate was greater in case group than control group (P<0.001). Conclusion: This study showed that intravenous aminophylline although, caused hemodynamic changes in some case, but it doesn't have any effect on prevention of incidence and severity of post-spinal anesthesia headache in elective cesarean section.