The Value of the Optic Nerve Sheath Diameter (ONSD) in Predicting Postdural Puncture Headache (PDPH): A Prospective Observational Study.

BACKGROUND

Postdural puncture headache (PDPH) is one of the serious complications after lumbar puncture, but there is no effective tool to predict it.

OBJECTIVES

To explore whether ultrasound measurement of optic nerve sheath diameter (ONSD) as a predictor of PDPH can be a reliable tool supported by reliable protocols and data.

STUDY

DESIGN

A prospective observational study.

SETTING

Department of Anesthesiology.

METHODS

This prospective observational study was performed in 156 patients undergoing cesarean section (CS). The patient's ONSD was recorded before anesthesia (T0), 10 minutes after anesthesia (T1), at the end of the operation (T2), at the first postoperative day (T24), at the second postoperative day (T48), and the third postoperative day (T72). During the 3-day follow-up, the patients were evaluated, identified, and divided into a PDPH group and a non-PDPH group. Age, weight, height, ASA, lumbar puncture location, and the number of lumbar puncture attempts were also recorded. We mainly analyzed the changes and differences between the 2 groups of ONSD.

RESULTS

Twenty-four patients (15%) developed PDPH. The ONSD was significantly lower in the PDPH group than in the non-PDPH group at T2, T24, T48, and T72. All patients showed a significant reduction in ONSD at T1 compared to T0. Women whose ONSD continued to fall without recovery from T0 to T2 were more likely to experience PDPH (RR 5. 022; 95 CI 3.343 to 7.508). The ONSD at T24 was the best predictor of PDPH (ACU 0. 9787, 95 CI 0.9578 to 0.9996), with a cutoff value of 0.40 cm (sensitivity 92%, specificity 94%).

LIMITATIONS: This is a single-center study, and ONSD may vary in different regions or ethnic groups.

CONCLUSIONS

We believe that continuous measurements of ONSD may be a useful tool for predicting PDPH.