Saudi journal of anaesthesia · 2026
Optic nerve sheath diameter as a prognostic tool for postdural puncture headache in pregnant women undergoing caesarean section under spinal anesthesia: A cross-sectional study.
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Amulya N, Kaparti Lavanya, Kumar Suresh N
Аннотация
CONTEXT: Postdural puncture headache (PDPH) is a common and debilitating complication following spinal anesthesia in obstetric patients, with few objective tools available for early prediction. Optic nerve sheath diameter (ONSD) measured by ultrasonography is a noninvasive surrogate marker of intracranial pressure changes and may aid in early risk stratification.
AIM: To evaluate the prognostic utility of ONSD measurements in predicting PDPH among pregnant women undergoing cesarean section under spinal anesthesia.
MATERIALS AND METHODS: This cross-sectional study included 88 pregnant women aged between 18 and 40 years undergoing cesarean section under spinal anesthesia. ONSD was measured using ultrasonography with a 13-6 MHz probe at baseline (T0) and at 4 (T4), 24 (T24), 48 (T48), and 72 h (T72) postprocedure. PDPH was diagnosed using International Classification of Headache Disorders criteria.
STATISTICAL ANALYSIS USED: Data were analyzed using SPSS version 22. Continuous variables were expressed as mean ± SD and categorical variables as frequencies and percentages. Student's t-test and Chi-square/Fischer's exact test were used as appropriate. Diagnostic performance was assessed using sensitivity, specificity, predictive values, and ROC curve analysis with calculation of area under the curve (AUC).
RESULTS: PDPH occurred in 12 patients (13.6%). Baseline ONSD values were comparable between groups. Patients who developed PDPH showed significantly lower ONSD values from T4 onward (P < 0.05). The best diagnostic performance was at T72 (AUC 0.776; 95% CI 0.663-0.889) with a cutoff ≤4.52 mm, yielding 91.7% sensitivity, 69.7% specificity, and 98.1% negative predictive value. ONSD reduction from baseline at T72 was significantly greater in the PDPH group (P < 0.001).
CONCLUSION: ONSD measurement at 72 h postspinal anesthesia is a sensitive and clinically useful prognostic tool for predicting PDPH in obstetric patients and may be incorporated into routine postoperative monitoring.
AIM: To evaluate the prognostic utility of ONSD measurements in predicting PDPH among pregnant women undergoing cesarean section under spinal anesthesia.
MATERIALS AND METHODS: This cross-sectional study included 88 pregnant women aged between 18 and 40 years undergoing cesarean section under spinal anesthesia. ONSD was measured using ultrasonography with a 13-6 MHz probe at baseline (T0) and at 4 (T4), 24 (T24), 48 (T48), and 72 h (T72) postprocedure. PDPH was diagnosed using International Classification of Headache Disorders criteria.
STATISTICAL ANALYSIS USED: Data were analyzed using SPSS version 22. Continuous variables were expressed as mean ± SD and categorical variables as frequencies and percentages. Student's t-test and Chi-square/Fischer's exact test were used as appropriate. Diagnostic performance was assessed using sensitivity, specificity, predictive values, and ROC curve analysis with calculation of area under the curve (AUC).
RESULTS: PDPH occurred in 12 patients (13.6%). Baseline ONSD values were comparable between groups. Patients who developed PDPH showed significantly lower ONSD values from T4 onward (P < 0.05). The best diagnostic performance was at T72 (AUC 0.776; 95% CI 0.663-0.889) with a cutoff ≤4.52 mm, yielding 91.7% sensitivity, 69.7% specificity, and 98.1% negative predictive value. ONSD reduction from baseline at T72 was significantly greater in the PDPH group (P < 0.001).
CONCLUSION: ONSD measurement at 72 h postspinal anesthesia is a sensitive and clinically useful prognostic tool for predicting PDPH in obstetric patients and may be incorporated into routine postoperative monitoring.