Comparison of sedative-dose propofol and dexamethasone on intensity and incidence of post-dural puncture headache after spinal anesthesia for elective cesarean section: A double-blind randomized clinical trial

Shamsa, Nasim; Karami, Tohid; Kharezi, Aydin

Volume 33, Issue 1 (Articles In Press 2026) J Transl Med Res. 2026, 33(1): 0-0 | Back to browse issues page

Research code: 13720

Ethics code: IR.UMSU.HIMAM.REC.1404.041

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Shamsa N, Karami T, Kharezi A. Comparison of sedative-dose propofol and dexamethasone on intensity and incidence of post-dural puncture headache after spinal anesthesia for elective cesarean section: A double-blind randomized clinical trial. J Transl Med Res. 2026; 33 (1)
URL: http://journal.bums.ac.ir/article-1-3599-en.html

Comparison of sedative-dose propofol and dexamethasone on intensity and incidence of post-dural puncture headache after spinal anesthesia for elective cesarean section: A double-blind randomized clinical trial

Nasim Shamsa ^*¹

, Tohid Karami²

, Aydin Kharezi³

1- Department of Anesthesiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran & Department of Anesthesiology, Kowsar Hospital, Urmia University of Medical Sciences, Urmia, Iran , Nasim.shamsa@gmail.com
2- Department of Anesthesiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran & Department of Anesthesiology, Kowsar Hospital, Urmia University of Medical Sciences, Urmia, Iran
3- Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran

Keywords: Cesarean section, Dexamethasone, Hemodynamics, Post-dural puncture headache, Propofol, Spinal anesthesia

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Background and Aims: Post-dural puncture headache (PDPH) is one of the most common complications of spinal anesthesia in women undergoing elective cesarean section, adversely affecting maternal quality of life, mother-infant bonding, and hospital stay. This study aimed to compare the effects of sedative-dose propofol and dexamethasone on the intensity and incidence of PDPH and hemodynamic changes.
Materials and Methods: This double-blind randomized clinical trial was conducted on 138 pregnant women (18-45 years, American Society of Anesthesiologists [ASA] I-II class) scheduled for elective cesarean section at Kosar Hospital, Urmia, Iran. Patients were randomly allocated to receive either intravenous dexamethasone 8 mg single dose or propofol infusion at 30 μg/kg/min immediately after fetal delivery. The primary outcome was the incidence of PDPH within the first 24 hours after surgery. Headache intensity was assessed using VAS at 9 time points (1, 2, 24 hours and days 2–7 postoperatively). Hemodynamic parameters (SBP, DBP, MAP, HR, SpO₂) were recorded at baseline and 1-, 2-, and 24-hours post-injection. Data were analyzed using Mann-Whitney U, Friedman, and Chi-square tests, as well as repeated measures analysis.
Results: No statistically significant difference was found between groups in terms of PDPH intensity or frequency at any follow-up time (P>0.05). The highest intensity and frequency of PDPH occurred at 24 hours and day 2, gradually decreasing to near zero by day 7. Hemodynamic changes were mild, self-limited, and comparable between groups with no serious adverse events.
Conclusion: Dexamethasone 8 mg IV and propofol 30 μg/kg/min did not show any clinically or statistically significant difference in preventing PDPH after spinal anesthesia for elective cesarean section. Both agents were hemodynamically safe. Emphasis on technical preventive measures is recommended.
Keywords: Cesarean section, Dexamethasone, Hemodynamics, Post-dural puncture headache, Propofol, Spinal anesthesia

Type of Study: Original Article | Subject: Anesthesiology
Received: 2026/02/18 | Accepted: 2026/05/5 | ePublished: 2026/06/5

References

1. Thomaidi S, Sarantaki A, Chatzopoulou MT, Orovou E, Jotautis V, Papoutsis D. The Rising Global Cesarean Section Rates and Their Impact on Maternal and Child Health: A Scoping Review. J Clin Med. 2025;14(22):8102. DOI: 10.3390/jcm14228102 [DOI:10.3390/jcm14228102] [PMID] [PMCID]

2. Pourshirazi M, Heidarzadeh M, Taheri M, Esmaily H, Babaey F, Talkhi N, et al. Cesarean delivery in Iran: a population-based analysis using the Robson classification system. BMC Pregnancy Childbirth. 2022;22(1):185. DOI: 10.1186/s12884-022-04517-1 [DOI:10.1186/s12884-022-04517-1] [PMID] [PMCID]

3. Jafarzadeh A, Hadavi M, Hasanshahi G, Rezaeian M, Vazirinejad R, Aminzadeh F, et al. Cesarean or cesarean epidemic? Arch Iran Med. 2019;22(11):663-70. https://pubmed.ncbi.nlm.nih.gov/31823633/

4. Gwanzura C, Gavi S, Mangiza M, Moyo FV, Lohman MC, Nhemachena T, et al. Effect of anesthesia administration method on apgar scores of infants born to women undergoing elective cesarean section. BMC Anesthesiol. 2023;23(1):142. DOI: 10.1186/s12871-023-02098-w [DOI:10.1186/s12871-023-02098-w] [PMID] [PMCID]

5. Chen Y, Liu W, Gong X, Cheng Q. Comparison of effects of general anesthesia and combined spinal/epidural anesthesia for cesarean delivery on umbilical cord blood gas values: a double-blind, randomized, controlled study. Int Med J Clin Res. 2019;25(1):52-72. DOI: 10.12659/msm.914160 [DOI:10.12659/MSM.914160] [PMID] [PMCID]

6. Li G, Zeng F, Qi X, Tan X, Wang H, Huang X, et al. Efficacy of fentanyl combined with bupivacaine and morphine for spinal anesthesia during cesarean section: A double-blind randomized controlled trial. J Int Med Res. 2025;53(11):03000605251389749. DOI: 10.1177/03000605251389749 [DOI:10.1177/03000605251389749] [PMID] [PMCID]

7. Delgado C, Ring L, Mushambi M. General anaesthesia in obstetrics. BJA Educ. 2020;20(6):201-10. DOI: 10.1016/j.bjae.2020.03.003 [DOI:10.1016/j.bjae.2020.03.003] [PMID] [PMCID]

8. Roofthooft E, Rawal N, Van de Velde M. Current status of the combined spinal-epidural technique in obstetrics and surgery. Best Pract Res Clin Anaesthesiol. 2023;37(2):189-98. DOI: 10.1016/j.bpa.2023.04.004 [DOI:10.1016/j.bpa.2023.04.004] [PMID]

9. ASo A. ASA physical status classification system. ASA House of Delegates. 2014.

10. Kim JE, Kim SH, Han RJW, Kang MH, Kim JH. Postdural puncture headache related to procedure: incidence and risk factors after neuraxial anesthesia and spinal procedures. Pain Med. 2021;22(6):20-5. DOI: 10.1093/pm/pnaa437 [DOI:10.1093/pm/pnaa437] [PMID]

11. Shui M, Zhao D, Xue Z, Wu A. Impact of spinal/epidural anesthesia versus general anesthesia on perioperative outcomes in patients undergoing lumbar spine surgery: an updated systematic review and meta-analysis. Clin Spine Surg. 2023;36(6):227-36. DOI: 10.1097/bsd.0000000000001374 [DOI:10.1097/BSD.0000000000001374] [PMID]

12. Choi JS, Chang SJ. A comparison of the incidence of post‐dural puncture headache and backache after spinal anesthesia: a pragmatic randomized controlled trial. Worldviews Evid-Based Nurs. 2018;15(1):45-53. DOI: 10.1111/wvn.12236 [DOI:10.1111/wvn.12236] [PMID]

13. Vallejo MC, Zakowski MI. Post-dural puncture headache diagnosis and management. Best Pract Res Clin Anaesthesiol. 2022;36(1):179-89. DOI: 10.1016/j.bpa.2022.01.002 [DOI:10.1016/j.bpa.2022.01.002] [PMID]

14. Chekol B, Yetneberk T, Teshome D. Prevalence and associated factors of post dural puncture headache among parturients who underwent cesarean section with spinal anesthesia: A systemic review and meta-analysis, 2021. Ann Med Surg. 2021;66:56-45. DOI: 10.1016/j.amsu.2021.102456 [DOI:10.1016/j.amsu.2021.102456]

15. Barkhori H, Arefi F, Hushmandi K, Daneshi S, Salehi J, Barkhori H, et al. Effects of dexamethasone on post-dural puncture headache in patients undergoing orthopedic surgery. The Open Pain Journal. 2020;13(1):37-28. DOI: 10.2174/1876386302013010042 [DOI:10.2174/1876386302013010042]

16. Okpala BC, Eleje GU, Ikechebelu JI, Ofojebe CJ, Ejikeme TB, Nwachukwu CE, et al. A double-blind placebo controlled trial on effectiveness of prophylactic dexamethasone for preventing post-dural puncture headache after spinal anesthesia for cesarean section. J Matern Fetal Neonatal Med. 2022;35(17):3407-12. DOI: 10.1080/14767058.2020.1818719 [DOI:10.1080/14767058.2020.1818719] [PMID]

17. Shakhsemampour F, Allahyari E, Rajabpour-sanati A, Sabertanha A. Evaluation the effect of dexamethasone on post-dural puncture headache in cesarean surgery. J Surg Trauma. 2018;6(1):6-10. http://jsurgery.bums.ac.ir/article-1-125-en.html

18. Khodadadi M, Pouladkhay F, Talaie A, Taghavi M, Sajjadi M, Mehmandoust R. Comparison of the Effects of Propofol and Midazolam Sedation on Post-dural Puncture Headache. Ann Mil Health Sci Res. 2023;21(3):48-39. DOI: 10.5812/amh-141446 [DOI:10.5812/amh-141446]

19. Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, et al. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev. 2018;2(3):e088. DOI: 10.5435/JAAOSGlobal-D-17-00088 [DOI:10.5435/JAAOSGlobal-D-17-00088] [PMID] [PMCID]

20. Fenta E, Kibret S, Hunie M, Teshome D. Dexamethasone and post-dural puncture headache in women who underwent cesarean delivery under spinal anesthesia: A systemic review and meta-analysis of randomized controlled trials. Ann Med Surg. 2021;62:104-13. DOI: 10.1016/j.amsu.2021.01.024 [DOI:10.1016/j.amsu.2021.01.024] [PMID] [PMCID]

21. Yousefshahi F. Dexamethasone increases the frequency of post-dural puncture headache (PDPH): an evidence based reality. Anesth Pain Med. 2016;7(1):e42426. DOI: 10.5812/aapm.42426 [DOI:10.5812/aapm.42426] [PMID] [PMCID]

22. Mohamed AG, Refky MA, Sayouh EF, Abdelnaby SM. The effect of intravenous infusion of propofol or aminophylline on incidence and severity of post-dural puncture headache in elective cesarean section. Egypt J Hosp Med. 2021;84(1):2646-54. https://journals.ekb.eg/article_189610.html [DOI:10.21608/ejhm.2021.189610]

23. Zhao G, Song G, Liu J. Efficacy of pharmacological therapies for preventing post-dural puncture headaches in obstetric patients: a Bayesian network meta-analysis of randomized controlled trials. BMC Pregnancy Childbirth. 2023;23(1):215. DOI: 10.1186/s12884-023-05531-7 [DOI:10.1186/s12884-023-05531-7] [PMID] [PMCID]