Prednisolone vs. pregabalin for post dural puncture headache :- Medznat
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Pregabalin vs. prednisolone: Which works better for PDPH?

Post Dural Puncture Headache Post Dural Puncture Headache
Post Dural Puncture Headache Post Dural Puncture Headache

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Oral pregabalin reduces post-dural puncture headache severity more effectively than oral prednisolone, with lower analgesic use and no need for an epidural blood patch.

In a prospective, double-blind, randomized study, pregabalin offered faster and greater pain relief for post-dural puncture headache (PDPH) than prednisolone. The goal was to compare the effectiveness of oral prednisolone and oral pregabalin against standard conservative treatment. In total, 63 PDPH-affected patients after lower limb surgery under spinal anesthesia were randomly divided into 3 groups:

  • Group C: Received conservative treatment with a vitamin tablet twice daily for 3 days to maintain blinding.
  • Group P: Received conservative treatment + oral prednisolone (20 mg once daily) along with a vitamin tablet for 3 days to ensure blinding.
  • Group G: Received conservative therapy in conjunction with oral pregabalin (150 mg twice daily) for 3 days.

Primary endpoints included pain severity (Visual Analog Scale [VAS] and modified Lybecker scores), while secondary outcomes assessed rescue analgesia use, epidural blood patch necessity, and drug-associated adverse effects. The intensity of headache illustrated no significant differences at baseline. At 12 and 24 hours post-treatment, Group G had markedly lower headache intensity when compared to Groups P and C, though there was no vital difference between Groups C and P at 12 hours.

By 48 and 72 hours, headache intensity remained highest in Group C, with no vital difference between Groups P and G. Ketorolac consumption was highest in Group C, while Group G required substantially less than Group P. Only 2 patients in Group C required an epidural blood patch, whereas none in Groups P or G needed one.

While the study supports the efficacy of both drugs in ameliorating PDPH severity, pregabalin emerged as the superior option. However, limitations—including a small sample size and limited literature on these treatments—necessitate further research to substantiate findings and refine PDPH care strategies.

Source:

Pain Physician

Article:

Comparative Study Between the Analgesic Effect of Prednisolone and Pregabalin in Managing Post Dural Puncture Headache After Lower Limb Surgeries

Authors:

Dina Abdelhameed Elsadek Salem et al.

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