Abstract
Interruption of daily caffeine consumption can cause caffeine withdrawal headache. As headache ranks among the most frequent minor postoperative sequelae, the impact of perioperative substitution of caffeine on the incidence of postoperative headache was evaluated Forty patients undergoing minor surgical procedures with general anaesthesia were randomly allocated to receive either placebo or caffeine tablets at a dosage equal to their individual average daily caffeine consumption. Daily dietary intake was calculated based on an average weekday consumption using conversion factors from previously published sources. The patients were instructed at the preoperative visit to abstain from all external sources of caffeine. Compliance with these dietary restrictions was verified by blood samples obtained immediately before the surgical procedure and on postoperative day 1. The patients were assessed for headache using a standardised checklist immediately before induction of anaesthesia, on the evening of the day of surgery and on the morning of postoperative day 1. Ten patients (50%) who received placebo reported headaches, which persisted in seven patients (35%) until the next day. No patient receiving caffeine substitution therapy reported headache following surgery, and only one complained of headache on postoperative day 1. We suggest that the prophylactic administration of caffeine tablets might be considered for surgical patients who are accustomed to a high daily intake of caffeine
Résumé
L’interruption de l’ingestion quotidienne de caféine peut provoquer de la céphalée par suppression. Comme la céphalée constitue une séquelle postopératoire très fréquente, l’impact du retrait de la caféine sur l’incidence postopératoire de la céphalée est évalué. Quarante patients soumis à une chirurgie mineure sous anesthésie générale sont répartis au hasard pour recevoir soit un placebo soit une dose de caféine en tablette équivalente à leur ingestion quotidienne. L’ingestion quotidienne est calculée sur la base de la consommation moyenne d’une journée modifiée avec un facteur de conversion tiré de publications antérieures. Lors de la visite préopératoire, les patients sont avisés d’éviter la caféine sous toutes ses formes. L’adhésion à ces restrictions est vérifiée par des échantillons de sang prélevés immédiatement avant l’intervention et la journée qui suit. L’évaluation de la céphalée est effectuée avec une formule standardisée avant l’induction, le soir de la chirurgie et le matin de la journée suivante. Dix patients (50%) qui ont reçu le placebo ont rapporté des céphalées, qui ont persisté chez sept patients (35%) jusqu’au lendemain. Aucun de ceux qui ont reçu le substitut ne s’est plaint de céphalée immédiatement après la chirurgie, et un seul s’en est plaint le lendemain. Nous suggérons d’administrer préventivement des tablettes de caféine aux patients habitués à une consommation quotidienne élevée de caféine.
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Hampl, K.F., Schneider, M.C., Rüttimann, U. et al. Perioperative administration of caffeine tablets for prevention of postoperative headaches. Can J Anaesth 42, 789–792 (1995). https://doi.org/10.1007/BF03011178
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DOI: https://doi.org/10.1007/BF03011178