Post-Dural Puncture Headache
Conditions
Brief summary
Postdural puncture headache (PDPH) is a common complication after cesarean delivery (CD). The role of peri-operative fluid therapy in prophylaxis against PDPH is unclear. The aim of this work is to compare restrictive versus liberal fluid therapy in prophylaxis against PDPH after CD
Detailed description
In this study, the investigators will compare restrictive fluid therapy and liberal fluid therapy in prophylaxis against postdural puncture headache. The restrictive group will not receive preoperative fluid loading, and will receive intraoperative crystalloids at rate of 10 mL/Kg/hour followed by postoperative crystalloids at rate of 2 mL/Kg/hour for hours. The Liberal group will receive preoperative fluid loading of 5 mL/Kg, and will receive intraoperative crystalloids at rate of 10 mL/Kg/hour, followed by postoperative crystalloids at rate of 6 mL/Kg/hour. Both groups will be compared regarding demographic data, total peri-operative fluids, incidence of postdural puncture headache, nausea, vomiting, and intraoperative hemodynamics (heart rate and systolic blood pressure) in addition to neonatal outcomes.
Interventions
This group will receive intraoperative crystalloids at rate of 10 mL/Kg/hour followed by postoperative crystalloids at rate of 2 mL/Kg/hour.
This group will receive crystalloid preload of 5 mL/Kg, then will receive intraoperative crystalloids at rate of 10 mL/Kg/hour followed by postoperative crystalloids at rate of 6 mL/Kg/hour.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Full term * Pregnant female * Scheduled to elective cesarean delivery
Exclusion criteria
* History of migraine headache * Hypertensive disorders of pregnancy * Cardiac morbidities, * Baseline systolic blood pressure \< 100 mmHg * Contraindication of regional anesthesia. * Patients with more than one single attempt for spinal block
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of post-dural puncture headache | 48 hours | the number of patients who develop post-dural puncture headache defined as pain scale above 4 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| incidence of post-spinal hypotension | 60 minutes | number of patients who develop hypotension defined as decrease of systolic blood pressure by more than 20% from the baseline reading after subarachnoid block |
| Wong-Baker faces pain scale | 48 hours | Pain rating scale which is expressed by the patient starting from zero scale which corresponds to no pain, till scale 10 which corresponds to worst pain |
| heart rate | 24 hours | the number of heart beats per minute |
| postoperative nausea and vomiting | 24 hours | the number of patients who develop postoperative nausea and vomiting |
Countries
Egypt
Outcome results
None listed