Hüseyin Utku YILDIRIM, Mesut BAKIR, Şebnem Rumeli ATICI

Evaluation of Theophylline Efficiency in Post-Dural Puncture Headache

Objective: In clinical studies, intravenous theophylline has been reported to be effective in thetreatment of postdural puncture headache (PDPH), but its efficacy is not clear to some cliniciansdue to the small number of patients in these studies. This treatment can be used as an intermediate step in the treatment of PDPH, if the efficacy and safety of theophylline is proven. We aimedto evaluate the efficacy and safety of an intravenous (IV) injection of theophylline on PDPH.Methods: Sixty-five PDPH patients who were injected with IV theophylline according to our “Postdural Puncture Headache Algorithm” were evaluated retrospectively. The primary and secondaryendpoints were the degree of headache and the patient’s overall response to the treatment,respectively. Treatment safety was evaluated based on the occurrence of adverse reactions.Results: Before the initial theophylline administration, the visual analog scale (VAS) score was6.0±1.6 points. The VAS scores at one hour post-treatment were 1.8±1.4 points. The mean VASscores of the patients after theophylline infusion decreased significantly compared to before(p=0.001). Hemodynamic changes due to theophylline were not statistically significant (p>0.05).There were no reports of theophylline-related adverse events in the patient records.Conclusion: An iv injection of theophylline is an effective and safe treatment for PDPH.Intravenous theophylline treatment may find a place between the conservative treatment andinvasive interventional therapy in step therapy of PDPH.

Postdural Delinme Baş Ağrısında Teofilin Etkinliğinin Değerlendirilmesi

Amaç: Klinik çalışmalarda, intravenöz teofilinin post-dural delinme baş ağrısı (PDBA) tedavisinde etkili olduğu bildirilmiştir, fakat bazı klinisyenlere göre çalışmalardaki hasta sayılarının az olması nedeniyle bu durum net değildir. Teofilinin etkinliği ve güvenliği kanıtlandığında, bu tedavi PDBA tedavisinde bir ara adım olarak kullanılabilir. Çalışmamızda, intravenöz (iv) teofilin uygulamasının PDBA üzerine etkinliğini ve güvenilirliğini değerlendirmeyi amaçladık. Yöntem: “Post-Dural Delinme Baş Ağrısı Algoritması” na göre intravenöz teofilin uygulanan 65 PDBA hastası retrospektif olarak değerlendirildi. Birincil ve ikincil sonlanım noktaları sırasıyla baş ağrısının derecesi ve hastanın tedaviye yanıtıydı. Tedavi güvenilirliği yan etki oluşumuna göre değerlendirildi. Bulgular: İlk teofilin uygulanması öncesi Görsel Analog Skala (VAS) skoru 6.0±1.6 idi. Tedaviden bir saat sonra VAS skorları 1.8±1.4 idi. Teofilin infüzyonu sonrası hastaların ortalama VAS skorları öncekine göre anlamlı olarak azaldı (p=0.001). Teofilin nedeniyle hemodinamik değişiklikler istatistiksel olarak anlamlı değildi (p>0.05). Hasta kayıtlarında teofilinle ilişkili yan etki bildirimi yoktu. Sonuç: İntravenöz teofilin uygulaması PDBA tedavisinde etkili ve güvenli bir yöntemdir. İntravenöz teofilin tedavisi, PDBA’nın basamak tedavisinde konservatif tedavi ve invaziv girişimsel tedavi arasında bir yer bulabilir.

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