Sphenopalatine ganglion block followed by an epidural blood patch for postdural puncture headache management in postpartum patients: is it a confounder?

Reply to Dr Araujo et al

“…Thanks to Araujo et al ,1 through the reanalysis of our data, we confirmed that at 0.5 hours and 1 hour post-treatment, more patients had headache symptom relief with the SPGB treatment and the SPGB+EBP treatment than with just the EBP treatment. This supports our original finding that a significant number of patients have a rapid and positive response to our SPGB, without the associated complications of EBP.…”

“…We would like to thank Araujo et al 1 for their interest in our study2 and their thoughtful comments. We are excited that anesthesiologists from other countries are also investigating post-dural puncture headache (PDPH) treatments, and we are happy to address any questions that we can.…”

“…Araujo et al 1 suggested that patients who received the SPGB on the initial treatment and then chose to receive the EBP for the second treatment may bias the conclusion and should be analyzed in a third group. We agree that crossover bias is a potential risk of the intent-to-treat analysis.…”

“…However, we were curious to see whether the potential crossover bias was concealing some part of our results, so we followed Araujo et al ’s1 suggestion and reanalyzed our data by subdividing our patients into three groups (table 1). Of the 81 patients who met the inclusion criteria of our retrospective review, 29 received just the SPGB, 13 received the SPGB followed by the EBP, and 39 received just the EBP.…”

Transnasal sphenopalatine ganglion block for treatment of post-dural puncture headache in obstetric population

“…As mentioned, no previous study has compared SGGB and EBP efficacy. [16] The results of our study indicate that since EBP includes many additional risks, SPGB may be a safer means of improving patient comfort and become the first choice of treatment approach in PDPH patients. In addition, in the SPGB group, there was no increase in VAS score during the day, and the clinical course was stable.…”