Neostigmine Methylsulfate intervention : A one milliliter syringe will contain 20 µg of Neostigmine methyl sulfate. 0.5 mg ampule (1 ml) will be diluted in 4 ml dextrose 5% to make a solution of 100 µg/ml, 0.2 ml of this solution will be added to 2.5 ml of hyperbaric bupivacaine 0.5 % used for intrathecal injection.

Dextrose 5% in water intervention : an equal volume (0.2 ml) of dextrose 5% will be added to 2.5 ml of hyperbaric bupivacaine 0.5 % used for intrathecal injection.

Post-Dural Puncture Headache

20 µg Neostigmine Methylsulfate intrathecal in 0.2 ml of Dextrose 5% solution

Neostigmine Methylsulfate

Dextrose 5% in water

Fayoum University hospital

Intrathecal Neostigmine for Prevention of PDPH

The Efficacy of Neostigmine as an Adjuvant to Bupivacaine for Intrathecal Block in Reducing the Incidence and Severity of Post-Dural Puncture Headache for Parturients Scheduled for Elective Caesarean Section

any headache that develops within five days of dural puncture and can't be attributed to any other types of headache and mostly is postural in character

Severity of PDPH at presentation estimated by visual analog score (VAS) (where 0 = no headache, and 100 = worst imaginable headache)

Severity of PDPH after 48 hours from receiving medical treatment estimated by visual analog score (VAS) (where 0 = no headache, and 100 = worst imaginable headache)

Severity of PDPH estimated by visual analog score (VAS) (where 0 = no headache, and 100 = worst imaginable headache)

incidence of neck stiffness in participants with PDPH in each group

Severe Intractable headache (VAS ≥ 40) persistent for more than 48 hours with no response to conservative measures will be managed with an epidural blood patch after participant approval and consent signing

Any intraoperative nausea or vomiting related to intrathecal neostigmine injection

Any postoperative nausea or vomiting related to PDPH

any observed or complained memory or cognitive disorders

systolic blood pressure (≤ 20 % of baseline level or < 90 mmhg

measured in minutes, assessed by a pinprick test

measured in minutes, assessed by the modified Bromage score (0, no motor loss; 1, inability to flex the hip; 2, inability to flex the knee; and 3, inability to flex the ankle)

esterase/صداع

Intrathecal Neostigmine for Prevention of PDPH

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