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Oral multidose caffeine-paracetamol combination is not effective for the prophylaxis of postdural puncture headache.

Esmaoglu A, Akpinar H, Uğur F

Department of Anesthesia, University of Erciyes, Kayseri, Turkey. aliye@operamail.com

STUDY OBJECTIVES: To investigate the effects of different doses of oral caffeine-paracetamol combinations in postdural puncture headache (PDPH) prophylaxis. DESIGN: Prospective, randomized, placebo-controlled, blinded study. SETTING: University hospital. PATIENTS: A total of 210 ASA physical status I and II patients undergoing lower extremity surgery. INTERVENTIONS: Patients were randomly divided into 3 groups. One hour before the spinal anesthesia, the first group (n = 70) received placebo, the second group (n = 70) received 500-mg paracetamol + 75-mg caffeine, and the third group (n = 70) received 500-mg paracetamol + 125-mg caffeine orally. The same doses were repeated every 6 hours for 3 days. Patients were then interviewed on days 1, 2, 3, 4, and 7 to inquire about any PDPH. The interviewer was unaware of the PDPH prophylaxis group members. Patients who were discharged early were interviewed by telephone. MEASUREMENTS AND MAIN RESULTS: Postdural puncture headache occurred in 11 patients (15.7%) in group 1, 10 patients (% 14.28) in group 2, and 10 patients (% 14.28) in group 3. The differences between the groups were insignificant (P > .05). The complications due to spinal anesthesia were similar in the 3 groups. Side effects of caffeine such as lack of sleep, tachycardia, and hypertension were not observed in groups 2 or 3. CONCLUSIONS: Prophylactic administration of paracetamol-caffeine combinations at the stated doses does not prevent PDPH.

Published 21 February 2005 in J Clin Anesth, 17(1): 58-61.
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