| Objective Postdural puncture headache(PDPH)is one of the serious complications after lumbar puncture.PDPH caused by intraspinal anesthesia is usually a serious and debilitating headache,which usually subsides within a week.However,it cannot be considered as completely benign and self-limiting.PDPH is related to acute and chronic severe sequelae.Any delay in diagnosis or treatment of PDPH may lead to serious consequences,for example,severe headaches,postpartum depression,etc.For cesarean section women,the probability of PDPH is much higher than that of other patients receiving intraspinal anesthesia.Prevention is far greater than treatment.Predicting the occurrence of PDPH in advance can effectively prevent the occurrence of PDPH,but there is no effective prediction tool at present.This study attempts to explore whether it is a reliable method to predict PDPH by measuring the optic nerve sheath diameter(ONSD)by ultrasound,and explore the threshold of ONSD when PDPH occurs.Methods 163 cases of cesarean section(CS)patients aged 18-40 years were selected from the obstetrics department of Chaohu Hospital affiliated to Anhui Medical University from October 18,2021 to April 28,2022.The proposed anesthesia method was combined spinal-epidural anesthesia,with 1%ropivacaine 1.8ml and 50% glucose solution 0.2ml.Preoperative records: age,weight,height,ASA grade.The patients were followed up for 3 days after operation,evaluated and identified,and divided into PDPH group and nonPDPH group.The main outcome measures were ONSD of patients before anesthesia(T0),ten minutes after anesthesia(T1),at the end of surgery(T2),24 hours after surgery(T24),48 hours after surgery(T48),72 hours after surgery(T72)and whether PDPH occurred three days after surgery.The secondary outcome measures were lumbar puncture location,lumbar puncture times,hemodynamic indexes,and occurrence of postoperative adverse reactions.We mainly analyzed the changes and differences of ONSD between the two groups.Results 1.At last,156 patients were statistically analyzed,and all patients completed 3-day follow-up.Among them,132 patients(85%)did not have PDPH after operation,and 24 patients(15%)had PDPH after operation.There was no significant difference between the PDPH group and the non-PDPH group in age,height,weight,ASA grade,lumbar puncture location and lumbar puncture times(P>0.05).2.There was no statistically significant difference in ONSD between PDPH group and non-PDPH group at T0(P=0.346)and T1(P=0.181).Compared with the non-PDPH group,the ONSD of patients in the PDPH group is smaller in T2,T24,T48 and T72.Compared with T0,the ONSD of PDPH group(P<0.05)and nonPDPH group(P<0.05)at T1 time was significantly lower.3.We found that the risk of postoperative PDPH was higher in women who did not show an upward trend of ONSD at T2(RR 5.022;95% confidence interval [CI]3.343～7.508,P<0.0001).4.ONSD at T24 is the most accurate parameter to predict PDPH.(ACU: 0.9787,P<0.05),cut-off value is 0.40 cm(92% sensitivity and 94% specificity).Conclusion 1.There is a potential correlation between the ONSD value measured by ultrasound and the occurrence of PDPH.This may become a useful predictor of PDPH in the future and is worth further study.2.Ultrasonic measurement of ONSD may be a non-invasive,valuable and easy to operate bedside evaluation of PDPH after combined spinal-epidural anesthesia.More clinical studies are needed to verify our findings and further improve them. |
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