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:
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.
Pain Physician
Comparative Study Between the Analgesic Effect of Prednisolone and Pregabalin in Managing Post Dural Puncture Headache After Lower Limb Surgeries
Dina Abdelhameed Elsadek Salem et al.
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