Topical Sphenopalatine Ganglion Block Compared With Epidural Blood Patch for Postdural Puncture Headache Management in Postpartum Patients: A Retrospective Review

Abstract

(Reg Anesth Pain Med. 2018;43(8):880–884) Postdural puncture headache (PDPH) is a severe and debilitating complication after regional anesthesia in the obstetric population. Approximately 80% of patients suffer from this type of headache after an accidental dural puncture. A PDPH can limit postpartum mother-baby interactions, extend hospital stays, and raise health care costs. The gold standard treatment for postpartum PDPH is an epidural blood patch (EBP). This retrospective study aimed to compare the effectiveness of treatment with EBP to treatment with a sphenopalatine ganglion block (SPGB).

Reply to Dr Araujo et al

“…This type of bias usually results in the failure to disprove the null hypothesis. In our study,2 however, we disproved the null hypothesis, which stated that no difference existed between SPGB and EBP effectiveness for PDPH treatment. In other words, since the results of our study already support the alternate hypothesis, reanalyzing our study by dividing the patients into three groups would unlikely change our original conclusion.…”

“…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.…”

“…Such treatment can result in all of the original complications of the neuraxial anesthesia, rarely including permanent spastic paraparesis and cauda equine syndrome 7. In our recent publication,2 we reported the results of the largest retrospective analysis to date comparing the effectiveness of EBP to that of the topical sphenopalatine ganglion block (SPGB) for PDPH treatment.…”

“…We originally organized our data into two groups based on the initial treatment choice of the patients 2. 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.…”

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

“…We would like to congratulate Cohen et al for their study1 comparing the effectiveness of sphenopalatine ganglion block (SPGB) to epidural blood patch (EBP) for treatment of postdural puncture headache (PDPH) evaluating pain relief obtained during 1 week. Their results show that pain relief after SPGB in the first hour is statistically significantly higher than with EBP, although that was not observed from at 24 hours, 48 hours, or 1 week.…”