Effect of Ondansetron for Preventing Post-dural Puncture Headaches After Spinal Anesthesia for Cesarean Section: A Randomized Controlled Trial

Background: Spinal anesthesia is the preferred anesthetic technique for cesarean sections due to its safety and efficacy. Post-dural puncture headaches (PDPH) are a relatively common complication. The aim of our study was to evaluate the role of ondansetron in preventing PDPH following spinal anesthesia (SA) for cesarean section. Methods: We conducted a prospective, randomized, controlled, double-blind, bicentric study at two centers in Tunisia. The study included parturients over 18 years who were scheduled to undergo cesarean section under spinal anesthesia. The patients were randomized into two groups: Group O who received 0.10 mg/kg of ondansetron and Group C who received saline. The primary outcome was the incidence of PDPH. Secondary outcomes were the effect of ondansetron on headache characteristics, the treatment required, the occurrence of nausea and/or vomiting, and hemodynamic status during and after surgery. Results: In total, 281 patients were included (141 in the O group versus 140 in the C group). Demographic, anthropometric and obstetric data were comparable. Patients in group O presented less PDPH (14.2%) than those in group C (27.9%) (p = 0.005) with an OR = 0.396 (95% CI = 0.210 – 0.746). The day of onset, duration and severity of headaches were similar in the two groups. The treatments used were also comparable, and no blood patch was required. Ondansetron significantly reduced intraoperative nausea and vomiting. However, it had no impact on postoperative symptoms. Hemodynamic parameters and norepinephrine requirements were comparable between the two groups. Conclusions: Ondansetron is effective in reducing the incidence of PDPH . Trial Registration: ClinicalTrials.gov Identifier: NCT06444737. Retrospectively registered. https://clinicaltrials.gov/study/NCT06444737. Date of registration: 13/05/2024