Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED

Kent, Sheffield; Mehaffey, Greg

doi:10.1016/j.ajem.2015.03.024

Cited by 35 publications

(28 citation statements)

References 9 publications

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“…For postdural puncture headache, the pain mechanism is thought to be secondary to cerebrospinal fluid leak that exceeds the production rate, causing traction on the meninges and parasympathetic mediated reflex vasodilatation of the meningeal vessels. SPG blockade is thought to work through blocking the parasympathetic flow to the cerebral vasculature, allowing the cerebral vessels to return to normal diameter, thus relieving the headache [ 4 ].…”

Section: Reviewmentioning

confidence: 99%

Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review

Przkora

Kumar

2017

J Headache Pain

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BackgroundSphenopalatine ganglion is the largest collection of neurons in the calvarium outside of the brain. Over the past century, it has been a target for interventional treatment of head and facial pain due to its ease of access. Block, radiofrequency ablation, and neurostimulation have all been applied to treat a myriad of painful syndromes. Despite the routine use of these interventions, the literature supporting their use has not been systematically summarized. This systematic review aims to collect and summarize the level of evidence supporting the use of sphenopalatine ganglion block, radiofrequency ablation and neurostimulation.MethodsMedline, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were reviewed for studies on sphenopalatine ganglion block, radiofrequency ablation and neurostimulation. Studies included in this review were compiled and analyzed for their treated medical conditions, study design, outcomes and procedural details. Studies were graded using Oxford Center for Evidence-Based Medicine for level of evidence. Based on the level of evidence, grades of recommendations are provided for each intervention and its associated medical conditions.ResultsEighty-three publications were included in this review, of which 60 were studies on sphenopalatine ganglion block, 15 were on radiofrequency ablation, and 8 were on neurostimulation. Of all the studies, 23 have evidence level above case series. Of the 23 studies, 19 were on sphenopalatine ganglion block, 1 study on radiofrequency ablation, and 3 studies on neurostimulation. The rest of the available literature was case reports and case series. The strongest evidence lies in using sphenopalatine ganglion block, radiofrequency ablation and neurostimulation for cluster headache. Sphenopalatine ganglion block also has evidence in treating trigeminal neuralgia, migraines, reducing the needs of analgesics after endoscopic sinus surgery and reducing pain associated with nasal packing removal after nasal operations.ConclusionsOverall, sphenopalatine ganglion is a promising target for treating cluster headache using blocks, radiofrequency ablation and neurostimulation. Sphenopalatine ganglion block also has some evidence supporting its use in a few other conditions. However, most of the controlled studies were small and without replications. Further controlled studies are warranted to replicate and expand on these previous findings.Electronic supplementary materialThe online version of this article (10.1186/s10194-017-0826-y) contains supplementary material, which is available to authorized users.

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Section: Reviewmentioning

confidence: 99%

Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review

Przkora

Kumar

2017

J Headache Pain

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“…On comparing the time taken to obtain clinical effect, SPGB provided a quicker and better relief than conservative measures. Adequate pain relief was obtained with 2% lignocaine,[ 21 ] as well as ropivacaine[ 18 ] when used to perform sphenopalatine block in obstetric patients with PDPH. These patients had pain relief for 12–24 h. The longer duration of analgesia achieved could be attributed to the use of longer acting local anaesthetic such as ropivacaine.…”

Section: Discussionmentioning

confidence: 99%

Sphenopalatine ganglion block for treatment of post-dural puncture headache in obstetric patients: An observational study

et al. 2018

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“…Post-dural puncture headache (PDPH) classically presents as a postural headache following therapeutic or diagnostic interventions of the epidural or spinal space. The incidence of PDPH is estimated to be between 30-50% following diagnostic or therapeutic lumbar puncture, 0-5% following spinal anaesthesia and up to 81% following accidental (1) dural puncture during epidural insertion in the pregnant woman .…”

Section: Introductionmentioning

confidence: 99%

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

Fares

Mohamed

Badawy

et al. 2020

IJAR

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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.

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Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED

Cited by 35 publications

References 9 publications

Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review

Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review

Sphenopalatine ganglion block for treatment of post-dural puncture headache in obstetric patients: An observational study

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

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