Restrictive versus liberal perioperative fluid strategies to prevent post-dural puncture headache after cesarean delivery

Background Post-dural puncture headache is a common complication after cesarean delivery. The role of fluid therapy in prevention of post-dural puncture headache is not clear. The aim of this work is to compare restrictive versus liberal perioperative fluid protocols in prevention of post-dural punc...

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Bibliographic Details
Published in:Ain-Shams journal of anesthesiology 2021-03, Vol.13 (1), p.1-6, Article 17
Main Authors: Elsonbaty, M., Agiza, Nora A., Abdelbarr, Tarek, Salah, Heba
Format: Article
Language:English
Subjects:
Anesthesiology
Blood pressure
Cesarean section
Critical Care Medicine
Fluids
Headaches
Heart rate
Hypotension
Intensive
Medicine
Medicine & Public Health
Nausea
Original Article
Pain
Patients
Prevention
Surgery
Vomiting
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Summary:Background Post-dural puncture headache is a common complication after cesarean delivery. The role of fluid therapy in prevention of post-dural puncture headache is not clear. The aim of this work is to compare restrictive versus liberal perioperative fluid protocols in prevention of post-dural puncture headache. A randomized controlled trial was conducted including 100 full-term pregnant women undergoing cesarean delivery under spinal block. After receiving spinal block, all patients received 1.5 mcg/kg phenylephrine and crystalloid co-load at a rate of 10 mL/h. Patients were assigned into either restrictive group (did not receive fluid preload + received postoperative crystalloid therapy at a rate of 2 mL/kg/h till resuming oral fluids) or liberal group (received crystalloid preload 5 mL/kg before spinal block + received postoperative crystalloids at a rate of 6 mL/kg/h till resuming oral fluids. Both groups were compared according to the incidence of post-dural puncture headache, pain scores, systolic blood pressure, heart rate, incidence of post-spinal hypotension, nausea, and vomiting. Results The incidence of post-dural puncture headache was lower in the restrictive group compared to the liberal group {10(20%) vs 22(44%), P = 0.018}. All other secondary outcomes were comparable between both groups. Conclusion Restrictive fluid therapy was associated with lower incidence of PDPH after cesarean delivery without impacting patient hemodynamic profile.
ISSN:2090-925X
1687-7934
2090-925X
DOI:10.1186/s42077-021-00134-w