• Qingcai Peng, Jiyuan Wang, Xiaoqiong Xia, Yuanhai Li, Cheng Qiu, Jun Li, Hongwang Zhou, Yawen Li, and Mingyue Zhang.
• Department of Anesthesiology, Chaohu Hospital Affiliated to Anhui Medical University, Hefei, China.
• Pain Physician. 2023 Jan 1; 26 (1): 455245-52.

BackgroundPostdural puncture headache (PDPH) is one of the serious complications after lumbar puncture, but there is no effective tool to predict it.ObjectivesTo 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 DesignA prospective observational study.SettingDepartment of Anesthesiology.MethodsThis 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.ResultsTwenty-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%).LimitationsThis is a single-center study, and ONSD may vary in different regions or ethnic groups.ConclusionsWe believe that continuous measurements of ONSD may be a useful tool for predicting PDPH.

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