Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy

Abstract

The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block has been used for a long time for treating headaches of varying etiologies. For anesthesiologists, treating postdural puncture headaches (PDPH) has always been challenging. The epidural block patch (EBP) was the only option until researchers explored the role of the SPG block as a relatively simple and effective way to treat PDPH. Also, since the existing evidence proving the efficacy of the SPG block in PDPH is scarce, the block cannot be offered to all patients. EBP can be still considered if an SPG block is not able to alleviate pain due to PDPH.

Postdural puncture headache in the obstetric population: a new approach?

“…Our results demonstrate that PNBs may be an attractive option to help with pain associated with PDPH. Previous studies show similar effectiveness of these techniques in pain relief, mostly regarding SPBG in isolation 5 7 13 14. Our results also suggest that the effect is less pronounced after the second course of PNB, possibly indicating a more refractory headache.…”

“…There has been increased interest in regional analgesic techniques for treatment of PDPH, due to their success in the treatment of other headache syndromes. Several case reports and case series have been published regarding the use of peripheral nerve blocks (PNBs) for PDPH, most of which report the use of sphenopalatine ganglion block (SPGB), greater occipital nerve block (GONB) and trigger point infiltration (TPI) 5–12…”

“…Blockade of the sphenopalatine ganglion interrupts parasympathetic flow to the cerebral vasculature. This opposes the excessive vasodilation induced by the CSF leak, allowing the vessels to return to their normal diameter and thus alleviating symptoms 5. Blockade of the greater occipital nerve interrupts the afferent somatic innervation of most of the occipital region 12.…”

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

“…Transnasal SPGB has been successfully used to treat chronic conditions such as migraine, cluster headache, and trigeminal neuralgia, and may be a safer alternative to treat PDPH: It is minimally invasive and carried out at the bedside without using imaging. Besides that, it has apparently a faster start than EBP, with (4) better safety prole .…”

Clinical Anatomy of Blockade of the Pterygopalatine Ganglion: Literature Review and Pictorial Tour Using Cadaveric Images

“…Ruskin [2] reviewed the remote effects of blocking the PPG and reported its efficacy for headaches, facial neuralgias, low back pain, temporomandibular joint dysfunction, and even hiccups. Subsequently, the classic and modified techniques and related anatomy have been well documented in numerous clinical studies [3][4][5] and reviews [6,7]. Because of the anatomical complexity of the pterygopalatine fossa (PPF) and sphenopalatine foramen (SPF), depiction and clarification of the needle trajectory for PPG blockade has been challenging.…”