A Cochrane review [Abstract] 1 included 10 studies with a total of 1611 subjects. The majority were women (72 %), mostly women in labour (n=913), after a lumbar puncture for regional anaesthesia. Drugs assessed were epidural and spinal morphine, spinal fentanyl, oral caffeine, rectal indomethacin, iv. cosyntropin, iv. aminophylline and iv. dexamethasone. The primary outcome, included in all RCTs, was the number of participants affected by post-dural puncture headache (PDPH) of any severity after a lumbar puncture. Epidural morphine (RR) 0.25; 95% CI 0.08 to 0.78; 1 trial, n=50) and iv. cosyntropin (RR 0.49; 95% CI 0.31 to 0.79; 1 trial, n=95) reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to placebo. Also, iv aminophylline reduced the number of participants affected by PDPH of any severity after a lumbar puncture when compared to no intervention (RR 0.16; 95% CI 0.05 to 0.51; 1 trial, n=120), while iv. dexamethasone increased it on one trial (RR 2.55; 95% CI 1.31 to 4.96; 1 trial, n=372) and did not have any efficacy in another (RR 0.79; 95% CI 0.43 to 1.45; 1 trial, n=178). Oral caffeine with doses of 75 mg and 125 mg, spinal morphine, spinal fentanyl and rectal indomethacin showed no significant risk reduction compared to placebo. Spinal morphine increased the number of participants affected by pruritus when compared to placebo, and epidural morphine increased the number of participants affected by nausea and vomiting when compared to placebo. Oral caffeine increased the number of participants affected by insomnia when compared to placebo.
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment), inconsistency (heterogeneity in treatments) and imprecise results (small study size for each comparison).
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