Effectiveness of Nebulized Dexmedetomidine in Managing Post-Dural Puncture Headache in Obstetric Patients: A systematic Review

Abstract

Post-dural puncture headache (PDPH) is a common complication after neuraxial anesthesia in obstetrics. While the epidural blood patch (EBP) remains as the gold-standard treatment, less invasive strategies are being increasingly explored. One such intervention is dexmedetomidine (DEX), an alpha-2-adrenergic agonist with analgesic and sedative properties. Method: A comprehensive literature search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. Studies evaluating nebulized dexmedetomidine for the treatment of PDPH following neuraxial anesthesia in obstetric patients were included. Comparator groups included saline (placebo), fentanyl, and neostigmine/atropine. The primary outcome was reduction in headache severity measured using the Visual Analog Scale (VAS). Secondary outcomes included adverse events and the need for additional interventions, including epidural blood patch. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Results: Five studies met the inclusion criteria. In most studies, nebulized dexmedetomidine was administered at a dose of 1 μg/kg diluted to a total volume of 4 mL and given every 12 hours for up to 72 hours. Compared with placebo, dexmedetomidine consistently reduced VAS pain scores at 24, 48, and 72 hours and decreased the need for additional treatments. Compared with fentanyl, dexmedetomidine provided superior headache relief, while demonstrating comparable efficacy to neostigmine/atropine. Patients receiving dexmedetomidine were less likely to require rescue therapies or epidural blood patch. Reported adverse events were infrequent and generally mild, including sedation, dry mouth, and bradycardia. Conclusion: Nebulized dexmedetomidine appears to be a safe, effective, and minimally invasive treatment option for PDPH in obstetric patients. It is associated with meaningful reductions in headache severity and may decrease the need for invasive interventions such as epidural blood patch. Larger, high-quality multicenter randomized controlled trials are needed to confirm these findings and define the role of nebulized dexmedetomidine in routine clinical practice.