Sphenopalatine ganglion block for the treatment of postdural puncture headache. Comment on Br J Anaesth 2020 124: 739–47

Sphenopalatine ganglion block for the treatment of postdural puncture headache. Reply to Br J Anaesth 2020; 124: 739–47

“…EditordWe thank Liu and Lim for their interest in our randomised study on the use of sphenopalatine ganglion block to treat postdural puncture headache, 1 in which we found sphenopalatine ganglion block given with local anaesthetic vs saline to have similar but large treatment effects in both groups, and a 50% and 55% avoidance of an epidural blood patch. It has been proposed that postdural puncture headache is caused by CSF leakage resulting in reduced ICP, but the actual mechanism is unclear.…”

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.…”