a B s t r a c t

BacKgroUND: Post-dural puncture headache (PDPH) is one of the most common complications of neuraxial anesthesia after an accidental dural puncture. this study aimed to test non-interventional alternatives to treat PDPH. our goals were to compare the effectiveness of nebulized dexmedetomidine (DeX) versus neostigmine/atropine in the conservative management of PDPH.

MetHoDs: a randomized double-blind controlled study of ninety (90) women divided into three equal groups: group c (given nebulization of saline 0.9% placebo in four ml), group N (given nebulization of 20 µ/kg neostigmine and 10 µ/ kg atropine diluted in four ml normal saline), and group D (given nebulization of dexmedetomidine 1 µg/kg diluted in four ml normal saline). Nebulization was done twice daily for three days, and a Visual analogue scale pain score (Vas) was recorded for seventy-two hours after the intervention for the three groups with a Vas score equal or less than three being the cutoff value.

RESULTS: VAS was significantly decreased in dexmedetomidine, and neostigmine/atropine groups compared to the

control group at six hours (median Vas: 5, 2, and 2 for groups c, N, and D respectively [P=0.001]). there was a significant difference in VAS trends between the three groups (at six, twelve, twenty-four, thirty-six, and forty-eight hours [P=0.001], and at seventy-two hours [P=0.003]). No patients in group D, but one patient in group N and seven patients in group c needed an epidural blood patch.

coNclUsioNs: Nebulized dexmedetomidine and neostigmine/atropine had a rapid effect on relieving PDPH after cesarean section.