{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T18:06:07Z","timestamp":1769277967421,"version":"3.49.0"},"reference-count":14,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T00:00:00Z","timestamp":1698883200000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec><jats:title>Key Clinical message<\/jats:title><jats:p>Neostigmine and atropine offer a promising treatment option for postdural puncture headache (PDPH) following spinal anesthesia in cesarean section, providing effective relief with a favorable risk\u2013benefit profile.<\/jats:p><\/jats:sec><jats:sec><jats:title>Abstract<\/jats:title><jats:p>Postdural puncture headache (PDPH) is a common consequence of cesarean section surgeries after spinal anesthesia. This case study describes the successful treatment of PDPH with intravenous neostigmine and atropine. A 31\u2009years female who underwent elective cesarean section with spinal anesthesia developed a severe headache on the 6th postoperative day and was diagnosed to have PDPH. PDPH failed to respond to conventional treatment modalities like hydration, a Non\u2010steroidal anti\u2010inflammatory drug, and sphenopalatine ganglion block. Epidural blood patch could not be performed due to lack of consent. A trial dose of intravenous neostigmine (20\u2009mcg\/kg) along with atropine (10\u2009mcg\/kg) successfully provided symptomatic and clinical relief. The combination of neostigmine and atropine demonstrates a rapid onset of action, providing patients with effective analgesia while avoiding the need for invasive procedures such as epidural blood patches and offers quicker pain relief. This promising result warrants additional research.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccr3.8132","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T03:53:47Z","timestamp":1698983627000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Neostigmine and atropine as a treatment for postdural puncture headache after spinal anesthesia in cesarean section: A case report"],"prefix":"10.1002","volume":"11","author":[{"given":"Indra Kumar","family":"Shrestha","sequence":"first","affiliation":[{"name":"Critical Care Medicine Nepal Mediciti  Lalitpur Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rupak","family":"Chalise","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Nepal Mediciti  Lalitpur Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0879-176X","authenticated-orcid":false,"given":"Saroj","family":"Poudel","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Nepal Mediciti  Lalitpur Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashim","family":"Regmi","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Nepal Mediciti  Lalitpur Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anup","family":"Ghimire","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Nepal Mediciti  Lalitpur Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bikash","family":"Khadka","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Nepal Mediciti  Lalitpur Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kishor","family":"Khanal","sequence":"additional","affiliation":[{"name":"Critical Care Medicine Nepal Mediciti  Lalitpur Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,11,2]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.4097\/kjae.2017.70.2.136"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeg231"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009199.pub3"},{"issue":"12","key":"e_1_2_12_5_1","first-page":"823","article-title":"Post\u2010dural puncture headache in the obstetric patient: an old problem New Solutions","volume":"70","author":"Kuczkowski KM","year":"2004","journal-title":"Minerva Anestesiol"},{"key":"e_1_2_12_6_1","first-page":"1","volume-title":"Headache Classification Committee of the International Headache Society (IHS) the International Classification of Headache Disorders","author":"Olesen J","year":"2018"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001791.pub2"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03023087"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03011749"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004144"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/2045-8118-8-7"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/jcbfm.2012.126"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11095-007-9324-2"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1517\/17425247.2016.1171315"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000003734"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.8132","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T05:20:21Z","timestamp":1702444821000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.8132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":14,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1002\/ccr3.8132"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.8132","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11]]},"assertion":[{"value":"2023-09-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e8132"}}