Synergistic Effect of a Selective Serotonin Reuptake Inhibitor and a Selective Cyclo-Oxygenase-2 Inhibitor on Post Spinal Anesthesia Headache

Abstract

Objective: To evaluate the synergistic effect of a Selective Serotonin Reuptake Inhibitor (SSRI) and a Selective Cyclooxygenase 2 Inhibitor (ISCOx-2) in the management of After Rachianesthesia Headache in Obstetric Care. Patients and Methods: This was an experimental double-blind, randomized, multi-center clinical trial of non-inferiority clinical trials over a 12-month period (May 1, 2018 to April 30, 2019) in six hospitals in southeastern DR Congo, including all patients undergoing surgery or analgesia on spinal anesthesia for obstetrical indication and with headache characteristic of a dural breccia, with no known causes, contraindications to experimental products and informed consent to been obtained. The patients were divided into four different groups depending on the protocol used, namely: Group A = Rehydration + Paracetamol, Group B = Rehydration + Celecoxib, Group C = Rehydration + Nefopam and Group 4 = Rehydration + Celecoxib + Nefopam (Study Group). Using the Statview II software, the statistical analyzes of data obtained from the different tests were made using the ANOVA test for comparing the averages of different samples using the Fisher test. Verification of the normality of the samples was made by the Kurtosis and Skewness flattening and asymmetry test. Results: The protocol associating Celecoxib and Nefopam significantly demonstrates its effectiveness in reducing CPRAOs in the first two days with a gradual decrease in anxiety and length of stay. In addition, the majority of patients (75.6%) had a high overall level of satisfaction with this protocol. Conclusion: The Nefopam-Celecoxib combination shows its effectiveness in the early reduction of these CPRAOs, anxiety and length of stay with a high overall level of patient satisfaction. Given the good tolerance and accessibility of these products, we strongly suggest the use of this protocol for its validation in our environment and elsewhere, although it is desirable to continue research on other non-explored alien pathways.