A simple modification of sphenopalatine ganglion block for treatment of postdural puncture headache: A case series

Abstract

To evaluate the efficacy of modified sphenopalatine ganglion block (MSPGB) to reduce the severity of post-dural puncture headache (PDPH). Five adult patients of both genders with age >18 years having PDPH intractable to conservative management were given modified sphenopalatine block in the postoperative period, and numeric rating scale (NRS) was recorded at regular intervals till the hospital discharge. MSPGB is a simple, noninvasive technique that provides instantaneous symptomatic relief in PDPH.

Efficacy and Safety of Trans-nasal Sphenoid Ganglion Block in Obstetric Patients With Post-dural Puncture Headache: A Randomized Study

“…However, a non-significant effect of local anesthetic in comparison to placebo in relieving PDPH was noted. Some case reports have suggested a modification for achieving an SPG block using an epidural catheter [14], nasal drops [15], and nasal spray [16]. However, a thorough literature search did not reveal a study that compared the two methods of achieving the trans-nasal SPG block used in our study.…”

“…However, in both the groups there was a reduction in pain from the baseline after the block (Table 3). This signifies that the trans-nasal SPG block, whether achieved by the applicator method or nasal spray method, does have a role as a non-invasive or minimally invasive method for the management of PDPH [8,[14][15][16]. Thus, it can be used as the first line of management, as the analgesia produced is rapid and effective in most cases.…”

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

“…Various approaches are practiced for SPG block like trans-nasal, trans-oral, sub-zygomatic, and lateral infratemporal approaches. The trans-nasal SPG block is a simple, noninvasive technique, 47 which can be achieved by local anesthetic administration through a hollow cotton tip applicator, trans-nasal local anesthetic spray or puffs, 48 trans-nasally inserted cotton gauze soaked in local anesthetic 49 and nasal drops of local anaesthetic, 50 although, the last three methods cannot ensure adequate concentration of local anesthetic reaching the effective site to be blocked. In this meta-analysis, one study compared SPG block with local anesthetic spray (lignocaine puffs) and subgroup analysis of the same observed superiority of SPG block over lignocaine puff for pain relief at 30 min, 1 h, 6 h, 12 h, and 24 h. However, this data was from only one study with a small sample size of 20 patients, therefore more studies with large sample sizes are needed for evaluating potential advantage of using local anesthetic spray or puff over trans nasal block with cotton tip applicator.…”

It is wrong to treat pain in CSF hypotension headache to allow the patient to walk!

“…Numerous published articles are bringing different alternatives in an attempt to treat a postural headache that is pathognomonic of cerebrospinal fluid (CSF) hypotension (Table 1). [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Even so, one of the most used drugs to prevent and treat post-lumbar puncture headache, caffeine, had its analgesic action questioned in a publication of notable reputation due to being insufficiently supported by the available pharmacological and clinical proofs. 24 In the intracranial space, there are three compartments: CSF, brain parenchyma, and blood.…”

“…Modified sphenopalatine ganglion block 4,8 Sphenopalatine block with lidocaine spray 6 Intranasal lidocaine atomization 5 Epidural blood patch [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] Synacthen depot 15 Tetracosactin 16 In a reduced volume of the CSF, in the case of fistula with loss of CSF, the pain is caused by the exit of the CSF from the intracranial space into the spinal dural sac. In order to keep the intracranial volume constant with the three mentioned compartments (i.e., brain parenchyma, CSF, and blood), there is vasodilation, mainly of the venous sinuses and large veins, as these vessels are quite innervated, the individual feels an intense headache when raising the head in relation to the trunk.…”