Transcranial Doppler role in prediction of post-dural puncture headache in parturients undergoing elective cesarean section: prospective observational study.

Abstract

Post-dural puncture headache (PDPH) may be resulted from significant changes in cerebral blood flow, which could be visualized by Transcranial Doppler (TCD). This study was performed to investigate if TCD can be used to predict the occurrence of PDPH in high-risk patients. This prospective observational study was conducted on ninety ASA I and II pregnant females undergoing elective cesarean section (CS) under spinal anesthesia. TCD was performed to all patients within 24h before the operation, at 24h and 48h in the post-operative period to measure mean velocity (MV) and Gosling pulsatility index (PI) in the right middle cerebral artery. For 5days postoperatively, all patients were assessed and the PDPH patients were identified, their pre- and post-puncture TCD measurements were compared with the corresponding measurements of PDPH-free patients and ROC analysis was done to evaluate the predictive value of TCD parameters. 17 patients (18.8%) developed PDPH. PDPH group was significantly higher regarding MV and significantly lower with regard to PI at all times except for the pre-spinal PI. The MV values in all patients showed statistical significant increase within the first 48h after CS as compared with those before delivery. In PDPH group there was high statistical significant decrease in PI values at 24h and 48h compared to the pre-puncture values. The pre-puncture MV was the parameter of the best accuracy for predicting PDPH with a cutoff of MV > 68.4cm/s and the post-puncture PI at 24h was the best predictive of PDPH with a cutoff value of < 0.75. TCD might prove a useful tool in predicting PDPH suggesting that higher pre-puncture MV with a cutoff value > 68.4cm/s and post-puncture lower PI at 24h with a cutoff < 0.75 are the best predictive parameters. This clinical trial was registered with ClinicalTrials.gov (NCT03464253).