Aslan AYDIN, Nureddin YÜZKAT
Van Medical Journal - 2026;33(4):389-399
Introduction: This study evaluated the effects of brochure-supported structured telemedicine counseling on the management of postdural puncture headache (PDPH), including pain severity, headache duration, self-reported adherence to relevant postdischarge recommendations, and hospital re-presentation, in patients undergoing cesarean delivery under spinal anesthesia. Materials and Methods: Pregnant women aged 18-49 years with an ASA physical status of II-III who were scheduled for cesarean delivery under spinal anesthesia were assessed for eligibility. After successful spinal anesthesia, 160 participants were randomized. Of these, 157 had evaluable postdischarge data and constituted the modified intention-to-treat population. Group S received standard information and telephone follow-up, whereas Group B additionally received brochure-supported structured telemedicine counseling. Participants were contacted on postdischarge days 1-5. The primary outcomes were Numeric Rating Scale headache pain scores and total headache duration among participants with telephone-identified suspected PDPH. These conditional analyses should be interpreted in the context of post-randomization selection. Results: Telephone-identified suspected PDPH occurred in 44.2% of Group S and 47.5% of Group B (p = 0.675). The mixed model showed a group-by-time interaction (p = 0.033); however, no between-group contrast at an individual postoperative time point remained significant after Holm adjustment, and headache duration did not differ significantly (p = 0.067). Exploratory analyses showed higher self-reported adherence in Group B (77.5% vs 41.6%; p = 0.001) and fewer PDPH-related hospital re-presentations (10.0% vs 28.6%; p = 0.003). Conclusion: Brochure-supported structured telemedicine counseling did not demonstrate a clear reduction in headache pain severity or duration. Exploratory findings regarding self-reported adherence and hospital re-presentation should not be interpreted as confirmatory evidence of clinical efficacy.
