Nebulized dexmedetomidine for post-dural puncture headache after cesarean delivery: a systematic review and meta-analysis
Abstract
Background: There are limited effective non-invasive treatment options for post-dural puncture headache (PDPH) following cesarean delivery. This meta-analysis aimed to investigate the efficacy and safety of nebulized dexmedetomidine in treating PDPH after cesarean delivery.
Methods: Electronic databases were systematically searched from the inception to March 2025. Primary outcomes included pain scores based on the numerical rating scale (NRS) and the visual analogue scale (VAS) at 6, 12, 24, 48, and 72 h after the intervention. Secondary outcomes included the need for epidural blood patch (EBP) and adverse events, such as bradycardia and dry mouth. The Cochrane Risk of Bias 2 (RoB 2) tool was employed to assess the quality of the included studies, and the certainty of evidence was evaluated using the grading of recommendations assessment, development, and evaluation (GRADE) approach.
Results: Four randomized controlled trials with 228 patients were included in this meta-analysis. Compared to participants in the control group who received saline or fentanyl, patients with PDPH who received nebulized dexmedetomidine following cesarean delivery exhibited lower pain scores at 6, 12, 24, 48, and 72 hours after the intervention. The quality of evidence ranged from 'very low' to 'moderate'. The nebulized dexmedetomidine group less frequently needed EBP compared to the control group, while there were no significant differences between the two groups in terms of adverse effects.…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 228 participants or records.
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