Nebulized dexmedetomidine for post-dural puncture headache after cesarean delivery: a systematic review and meta-analysis.

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. CONCLUSION: Nebulized dexmedetomidine is a promising non-invasive option for managing PDPH in patients undergoing cesarean delivery. It effectively reduces pain intensity and decreases the need for invasive procedures, such as epidural blood patches, with an acceptable safety profile. This nebulized delivery method may offer practical advantages over traditional systemic approaches, particularly in the postpartum setting. TRIAL REGISTRATION: We registered this network meta-analysis with PROSPERO (registration no. CRD420251016279).