Comparison of the effect of intravenous caffeine, dexamethasone and aminophylline injection on headache after spinal anesthesia in patients undergoing section surgery

To determine and compare the effects of intravenous caffeine, dexamethasone, and aminophylline on the prevention of post–spinal anesthesia headache in patients undergoing cesarean section.

This randomized clinical trial uses block randomization to assign eligible cesarean section patients to four groups. Outcomes are compared to evaluate each drug’s effectiveness in preventing post-spinal anesthesia headache.

The study at Imam Sajjad Hospital will randomly assign cesarean patients to four groups, administer interventions after delivery, and assess headache 24 hours later using VAS.

Inclusion criteria: no prior history of spinal anesthesia or post-dural puncture headache; spinal anesthesia performed by an anesthesiologist using the same needle size and with only one puncture attempt. No personal history of migraine headaches. No contraindications to the study medications. Candidates for elective cesarean section under spinal anesthesia at Imam Sajjad Hospital, Yasuj. Exclusion criteria: known allergy or contraindication to any of the study medications. Use of additional oral or injectable analgesics during the study period. Presence of headache prior to the surgery. Withdrawal from participation or unwillingness to continue cooperation.

Control group: Intravenous placebo (distilled water) after delivery and placental separation.Caffeine group: Intravenous caffeine 500 mg in 500 mL normal saline, administered after delivery; second dose after 12 hours with monitoring for tachycardia and arrhythmia. Dexamethasone group: Single 8 mg intravenous dexamethasone after delivery. Aminophylline group: Intravenous aminophylline at 0.4 mg/kg/hour after delivery.

Post-spinal anesthesia headache severity measured using the 0–10 Visual Analogue Scale.

Randomization was performed using block randomization to ensure balanced allocation across the four study groups. After obtaining written informed consent at the entrance to the operating room, eligible patients were randomly assigned to one of the four groups (control/placebo, caffeine, dexamethasone, or aminophylline). Fixed blocks of four were used, with each group appearing once in each block. The allocation order within each block was determined using a random number table, and this process continued until equal group sizes (35 participants per group) were achieved.