Response to question: Is intranasal oxytocin useful in preventing post-dural puncture headache in caesarean section? A randomised clinical trial

Background
Post-dural puncture headache (PDPH) as an annoying complication after spinal anaesthesia and is of great importance in patients undergoing caesarean section.

Objectives
This study aimed to evaluate the effect of nasal oxytocin on the incidence and severity of PDPH after caesarean section.

Material and methods
This double-blinded randomised clinical trial was carried out on 170 patients undergoing elective caesarean section in Kamali Hospital, Karaj, Iran, from May 2021 to September 2021. Participants were randomly assigned to receive three puffs of intranasal oxytocin (30 IU) (intervention group) or intranasal normal saline (0.3 ml of 0.09% saline solution) (control group) as a placebo right after delivery. The occurrence of PDPH was the primary outcome, and participants were also asked about the use of analgesics and associated symptoms.

Results
The results showed that the rate of PDPH was not significantly different between the two groups at 12 (p = 0.108) and 72 (p = 0.245) hours after surgery, but it significantly reduced the incidence of PDPH at 24 (p = 0.022) and 48 hours (p = 0.042). Oxytocin did not reduce the analgesic requirement compared to the control group (p > 0.05). Oxytocin did not significantly mitigate PDPH associated symptoms, including tinnitus, vertigo, nausea and double vision (p > 0.05).

Conclusions
Administration of intranasal oxytocin in combination with routine analgesic for post-dural puncture headache after caesarean section is beneficial and reduces the incidence of headache after 24 and 48 hours of surgery. Use of nasal oxytocin has no effect on the need for sedation and reduction of associated symptoms (dizziness, diplopia, nausea, tinnitus).