Restrictive versus liberal perioperative fluid strategies to prevent post-dural puncture headache after cesarean delivery
Tóm tắt
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. 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. Restrictive fluid therapy was associated with lower incidence of PDPH after cesarean delivery without impacting patient hemodynamic profile.
Tài liệu tham khảo
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