Comparative Study Between Lidocaine 2%, Lidocaine 5% And Bupivacaine 0.5% in Transnasal Sphenopalatine Ganglion Block for the Treatment of Postdural Puncture Headache

Abstract

BACKGROUND: Postdural puncture headache (PDPH) is a complication commonly related to neuraxial anesthesia and dural puncture, with an incidence proportional to the diameter of the needle, ranging from 2% with a 29G to 10% with a 27G and 25% with a 25G. The development of ne gauge spinal needles and needle tip modication, has enabled a signicant reduction in the incidence of postdural puncture headache. PDPH presents as a dull throbbing pain with a frontal-occipital distribution. PDPH is thought to be due to a cerebrospinal uid leak that exceeds the production rate, causing downward traction of the meninges and parasympathetic mediated reex vasodilatation of the meningeal vessels. The sphenopalatine ganglion (SPG) is an extracranial neural structure located in the pterygopalatine fossa that has both sympathetic and parasympathetic components as well as somatic sensory roots. Sphenopalatine ganglion block (SPGB) has been used for the treatment of migraine, cluster headache and trigeminal neuralgia and can be performed through transcutaneous, transoral or transnasal approaches. Obstetric patients are considered at increased risk for this condition because of their sex, young age, and the widespread use of neuraxial blocks. SPGB is minimally invasive, carried out at the bedside without using imaging and has apparently rapid onset than EBP with better safety prole. The most common side effects of SPGB are all temporary, including numbness in the throat, low blood pressure and nausea. OBJECTIVES: We evaluated the efcacy and safety of lidocaine 2%, lidocaine 5% and bupivacaine 0.5% in transnasal sphenopalatine ganglion block for the treatment of post dural puncture headache on 30 patients. PATIENTS AND METHODS: This prospective, randomized and controlled clinical study was conducted at Sohag University Hospital after its approval by the Ethics and Research Committee of Sohag Faculty of Medicine. Written informed consent was obtained from each patient before participation. RESULTS: Our study showed that there were non signicant differences between the three studied groups regarding age, gender, body mass index, type of operation, onset, site of headache, associated symptoms, relieving factors and exaggerated follow up. There was a nonsignicant difference between the three studied groups regarding changes in visual analogue score for severity of headache. There were nonsignicant differences between the three studied groups regarding presence of bleeding and results of treatment of postdural puncture headache. CONCLUSION: SPGB is an effective initial modality for managing severe headache in patients with PDPH.

Transnasal Sphenopalatine Ganglion Block for the Preventive Treatment of Chronic Daily Headache in Adolescents

“…A retrospective study evaluating 386 SPG blocks for headache found no difference between bupivacaine and lidocaine for pain reduction [21]. A randomized controlled study of 90 patients compared SPG block with lidocaine 2%, lidocaine 5%, and bupivacaine 0.5% for treating post-dural puncture headache and again found no difference between the groups [22].…”

Sphenopalatine Ganglion Block versus Conservative Management for Post Dural Puncture Headache in Cesarean Section

“…had also mentioned about no significant difference while comparing three local anesthetic drugs such as lidocaine 2%, lidocaine 5% and Bupivacaine 0.5% in their study. 3 Purva Kumrawat et al 10 mentioned in their study which was done in 18 parturients who underwent C-section under spinal anesthesia that SPGB is more effective than conservative management in the treatment of PDPH in the first 24 hrs. SPGB has faster onset of action versus conservative management.…”

“…1,2 The incidence and severity of PDPH varies according to the types, bores of needle and number of attempts. 3 The first response to PDPH in the clinical practice is conservative management which fails to show prompt result and it may take up to 7-10 days. However, The gold standard treatment for PDPH is an autologous epidural blood patch (AEBP), 4,5 which has its own set of advantages and disadvantages.…”