effect of prophylactic intravenous neostigmine on post-dural puncture headache in parturients undergoing spinal anesthesia for cesarean section: a double-blind randomized placebo-controlled study

Intrathecal anesthesia is considered as one of the most prevalent and widely utilized anesthetic techniques for cesarean sections worldwide, with post-dural puncture headache (pdph) being a distressing complication of spinal anesthesia. it results in prolonged hospitalization, increased costs, and a negative impact on patient satisfaction. neostigmine is a quaternary amine that reversibly inhibits the cholinesterase enzyme. nevertheless, studies have revealed that neostigmine can be helpful in the treatment of pdph. consequently, this study aims to evaluate the impact of prophylactic intravenous neostigmine on eliminating the incidence of pdph. one hundred and eighty pregnant females aged 18–35 years (asa ii, using intrathecal anesthesia) undergoing elective cesarean sections were randomized into two groups. after umbilical cord clamping, the neostigmine group received intravenous (20 μg/kg) neostigmine as well as (0.02 mg/kg) atropine. in contrast, the control group received intravenous (0.9%) saline. the primary outcomes were the duration, severity, incidence, onset, and intensity of pdph. as a secondary outcome, postoperative pain, time to first analgesia, and hemodynamics were examined. the neostigmine group had a pdph incidence of 2.2%, which was substantially lower than controls (13.30 %; p = 0.003). the intensity and duration of pain in the neostigmine group were considerably lower than in controls. the neostigmine group had lower postoperative pain scores and required less rescue analgesia. prophylactic intravenous neostigmine (20 μg/kg i.v) has been proven to alleviate the severity and incidence of pdph in parturients undergoing cesarean sections using spinal anesthesia, with no associated side effects.