Yang Qiao, Deng Ruiming, Weng Qiaoling, He Tingyu, Dong Ziqiang, Jin Xianwei, Zhong Weibo
Department of Anesthesiology, Ganzhou Maternal and Child Health Care Hospital, No. 25, Nankang Road, Ganzhou, 341000, Jiangxi Province, China.
Department of Anesthesiology, Ganzhou People's Hospital, Ganzhou, Jiangxi Province, China.
Sci Rep. 2025 Jun 4;15(1):19521. doi: 10.1038/s41598-025-02979-9.
In cesarean section surgery, spinal anesthesia can lead to a reduction in intracranial pressure (ICP), which may result in headaches. Adequate fluid replacement is generally required postoperatively to prevent low ICP. However, excessive empirical fluid replacement can increase the circulatory burden on the patient and potentially elevate ICP, thereby contributing to the occurrence of headaches. This trial aims to investigate whether fluid management guided by ultrasound measurement of the optic nerve sheath diameter can reduce the incidence of postoperative headaches in patients. This single-center randomized controlled clinical trial was conducted at Ganzhou People's Hospital in China from December 2022 to July 2023. A total of 138 ASA II and III patients aged 18 years and older, scheduled for cesarean section under spinal anesthesia, were randomly assigned to either a restricted infusion group (Group E, n = 71), which underwent restrictive infusion adjustments to maintain the optic nerve sheath diameter within the normal range (2.2-5 mm), or an empirical infusion group (Group C, n = 67), where the optic nerve sheath diameter was solely monitored, and empirical infusion treatment was employed. Within 72 h post-operation, all patients were monitored every 12 h for ultrasound-measured optic nerve sheath diameter (ONSD) and the occurrence of postoperative headaches. The primary outcome was the incidence of postoperative headaches. Secondary outcomes included ONSD assessed by ultrasound, pain scores using the visual analog scale (VAS), postoperative fluid supplementation, nausea and vomiting, back pain, mean arterial pressure (MAP), heart rate (HR), length of hospital stay, and patient satisfaction. The incidence of postoperative headache in Group E was lower than that in Group C, however, this difference was not statistically significant (P = 0.094). There was no difference in the volume of fluid replacement between the two groups within the first 0-12 h post-surgery, but significant difference was observed between 12 and 24 h (P = 0.002). Additionally, there was no significant reduction in discharge time between two groups (P = 0.309). Under ultrasound guidance, maintaining a normal diameter of the optic nerve sheath does not decrease the incidence of postoperative headaches in women with cesarean section receiving a spinal anesthesia. However, it may offer patients a more effective approach to fluid replacement.Trial registration: ChiCTR.org.cn (ChiCTR2400089214). Date of registration: 4/9/2024.
在剖宫产手术中，脊髓麻醉可导致颅内压（ICP）降低，这可能会引发头痛。术后通常需要充分补液以防止ICP过低。然而，过度的经验性补液会增加患者的循环负担，并可能升高ICP，进而导致头痛的发生。本试验旨在研究通过超声测量视神经鞘直径来指导液体管理是否能降低患者术后头痛的发生率。这项单中心随机对照临床试验于2022年12月至2023年7月在中国赣州市人民医院进行。共有138例年龄在18岁及以上、计划在脊髓麻醉下进行剖宫产的ASA II级和III级患者，被随机分配至限制输液组（E组，n = 71），该组通过进行限制性输液调整，以将视神经鞘直径维持在正常范围内（2.2 - 5毫米），或经验性输液组（C组，n = 6），该组仅对视神经鞘直径进行监测，并采用经验性输液治疗。术后72小时内，每12小时对所有患者进行超声测量视神经鞘直径（ONSD）及术后头痛发生情况的监测。主要结局指标为术后头痛的发生率。次要结局指标包括通过超声评估的ONSD值、采用视觉模拟评分法（VAS）的疼痛评分、术后补液量、恶心呕吐、背痛、平均动脉压（MAP）、心率（HR）、住院时间及患者满意度。E组术后头痛的发生率低于C组，但这种差异无统计学意义（P = 0.094）。两组术后0至12小时内的补液量无差异，但在12至24小时之间观察到显著差异（P = 0.002）。此外，两组之间的出院时间无显著缩短（P = 0.309）。在超声引导下，维持剖宫产脊髓麻醉女性视神经鞘的正常直径并不能降低术后头痛的发生率。然而，它可能为患者提供一种更有效的补液方法。试验注册：中国临床试验注册中心（ChiCTR.org.cn）（ChiCTR2400089214）。注册日期：2024年4月9日。
