BACKGROUND: Sphenopalatine ganglion block (SPGB) is traditionally advised in the management of head and neck pain. Since SPGB is a minimally invasive, repeatable, and simple technique, SPGB should be tried first in the management of postdural puncture headaches (PDPH). Verification of the block’s success in diagnostic, prognostic, and therapeutic nerve blocks, is of paramount importance in pain management. OBJECTIVES: This study intends to prove the ability of SPGB in the management of PDPH. Transcranial Doppler (TCD) is utilized as an objective measure to assess the block’s success by monitoring variations in the cerebral hemodynamics before and after the block procedure. Noninvasive intracranial pressure (nICP) was applied to support the theory which assumes that the vasodilation of the cerebral blood vessels is the precipitating cause of the PDPH, rather than intracranial hypotension. STUDY DESIGN: Prospective, triple blinded, controlled, clinical trial. SETTING: This clinical trial was conducted at Zagazig University. METHODS: In the present study, 123 patients were considered who had spinal and/or epidural anesthesia; 63 patients who developed PDPH joined treatment group A and received the SPGB block. The control group B included 60 patients with no PDPH. The patients in group A were evaluated preprocedure by a numerical pain score and at 30 minutes, 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours postprocedure. Furthermore, patients in both groups were evaluated employing TCD before the transnasal block was given, then it was repeated to group A only within one hour after the block. RESULTS: Results analysis revealed that preprocedural pulsatility index (PI) and mean flow velocity (MFV) values in treatment group A were (mean ± standard deviation [SD]) 0.63 ± 0.04 and 57.20 ± 4.85 cm s-1, respectively. Values of PI and MFV were significantly increased up to (mean ± SD) 0.87 ± 0.08 and 71.15 ± 7.686 cm s-1, respectively after the block. The computed nICP values preblock and postblock were also within the normal range. LIMITATIONS: Performing SPGB without standardized equipment may limit the results of the current study CONCLUSIONS: SPGB should be considered as a first treatment modality for PDPH. Moreover, the results indicate that TCD is a successful objective tool in assessing a transnasal sphenopalatine ganglion block. KEY WORDS: Noninvasive intracranial pressure, postdural puncture headache, sphenopalatine ganglion block, transcranial Doppler

Background: Glasgow coma scale (GCS) is a familiar scoring system with a standard statistical association with neurological outcome, it has many limitations that minimize its ability in prediction of Traumatic brain injury (TBI) patients' outcome. Transcranial Doppler (TCD) is a noninvasive aid in this field that can improve outcome prediction. Objective: This study aims to explore the effect of combination of GCS and Pulsatility Index (PI) in the prediction of outcome of TBI patients. Patients and Method: This study was performed in Zagazig University Hospital (ZUH). 103 traumatic brain injured patients were engaged in the investigations with hospital days of 1, 2, 3, and 7 or until patient discharge. The study was performed by TCD along with GCS recordings. Prognosis was also assessed by the Glasgow outcome scale (GOS). Results: The sensitivity and negative predictive value of PI was more than GCS in TBI patients (GCS 3-15), as they were (67.5% versus 50%) and (81.1% versus 74.3%), respectively. The combination of both PI and GCS increased the sensitivity and the negative predictive value up to 70% and 83.3%, respectively. PI had higher sensitivity, positive and negative predictive values than GCS in the identification of secondary neurologic deterioration (SND) in mild and moderate TBI patients (73.3% versus 40.0%, 61.1% versus 50.0%, and 92.0% versus 83.9%, respectively), while the combined value of both PI and GCS increased both sensitivity and positive predictive value up to 76.7% and 66.7%, respectively. Conclusion: The combination of GCS and PI would improve the prediction of outcome.

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