Neostigmine and atropine as a treatment for postdural puncture headache after spinal anesthesia in cesarean section: A case report

• Published in: Clinical case reports Vol. 11; no. 11; pp. e8132 - n/a
• Main Authors: Shrestha, Indra Kumar, Chalise, Rupak, Poudel, Saroj, Regmi, Ashim, Ghimire, Anup, Khadka, Bikash, Khanal, Kishor
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.11.2023; John Wiley and Sons Inc; Wiley
• Subjects: Anesthesia; atropine; Case Report; Case reports; Cerebrospinal fluid; Cesarean section; Conflicts of interest; Critical Care Medicine; Diagnostic tests; Drug dosages; Editing; Epidural; epidural blood patch; Headaches; Hematoma; intensive care unit; Meningitis; neostigmine; Neurology; PDPH; spinal anesthesia; Supervision; Writing; PDPH; epidural blood patch; intensive care unit; neostigmine; spinal anesthesia; atropine
• ISSN: 2050-0904; 2050-0904
• DOI: 10.1002/ccr3.8132

Key Clinical message Neostigmine and atropine offer a promising treatment option for postdural puncture headache (PDPH) following spinal anesthesia in cesarean section, providing effective relief with a favorable risk–benefit profile. Postdural puncture headache (PDPH) is a common consequence of cesarean section surgeries after spinal anesthesia. This case study describes the successful treatment of PDPH with intravenous neostigmine and atropine. A 31 years female who underwent elective cesarean section with spinal anesthesia developed a severe headache on the 6th postoperative day and was diagnosed to have PDPH. PDPH failed to respond to conventional treatment modalities like hydration, a Non‐steroidal anti‐inflammatory drug, and sphenopalatine ganglion block. Epidural blood patch could not be performed due to lack of consent. A trial dose of intravenous neostigmine (20 mcg/kg) along with atropine (10 mcg/kg) successfully provided symptomatic and clinical relief. The combination of neostigmine and atropine demonstrates a rapid onset of action, providing patients with effective analgesia while avoiding the need for invasive procedures such as epidural blood patches and offers quicker pain relief. This promising result warrants additional research. Understanding the pathophysiology of postdural puncture headache and the mechanisms of action of neostigmine and atropine for treatment.