Comparison of Efficacy and Efficiency of Trans-Nasal Spheno-Palatine Ganglion Block for the Management of Post-Dural Puncture Headache
DOI:
https://doi.org/10.25751/rspa.41691Keywords:
Anesthetics, Local, Blood Patch, Epidural, Ganglionic Blockers, Post-Dural Puncture HeadacheAbstract
Introduction: Epidural blood patch (EBP) is the standard treatment for refractory post-dural puncture headache (PDPH) following caesarean section (C/s), but is invasive and associated with rare yet serious complications. A minimally invasive alternative is the trans-nasal sphenopalatine ganglion block (TNSPGB). This study compared the efficacy and efficiency of TNSPGB in achieving pain reduction, defined as a decrease of ≥2 points on the Numeric Rating Scale (NRS).
Methods: This single-centre, prospective interventional study was conducted after ethical approval. Forty-four patients with PDPH were allocated equally into two groups. Group I received EBP, and Group II received TNSPGB with 1.4 mL local anaesthetic (0.7 mL lidocaine 4% plus 0.7 mL ropivacaine 0.5%). Hemodynamic variables, pain scores, onset and duration of analgesia, adverse effects, total paracetamol dose, patient satisfaction, and hospital stay within 24 h were recorded.
Results: Baseline pain scores were comparable between groups (p=0.457). The onset of analgesia was significantly faster in Group II than Group I (18.2±4.4 vs 62.3±11.8 min, p<0.001) and they reported lower NRS during 1 hour. After that, Group I reported significantly lower NRS at 2 and 4 hours (p< 0.001). At 8, 12 and 24 hours, pain scores were similarly low (NRS-1 to 3) in both groups (all p>0.05). There were no significant differences between the groups regarding hemodynamic, pain scores, duration of analgesia, adverse effects, rescue analgesia, and patient satisfaction within 24 hours after the intervention.
Conclusion: TNSPGB with local anaesthetics provides effective, rapid, safe, and minimally invasive pain relief for PDPH following C/s and is comparable to EBP.
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References
1. The Incidence of Post-Dural Puncture Headache and Associated Factors Among Mothers Undergoing Cesarean Section at the Largest Tertiary Teaching Hospital in Botswana. European J Med Health Sci. 2025; 7 :25-31. doi: 10.24018/ejmed.2025.7.3.2301.
2. Mowafi MM, Abdelrazik RA. Efficacy and efficiency of sphenopalatine ganglion block for management of post-dural puncture headache in obstetric patients: a randomized clinical trial. Ain-Shams J Anesthesiol. 2022;14:73.
3. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38:1-211.
4. Postdural Puncture Headache. [accessed Jan 2025] Available at: https://www.nysora.com/topics/complications/postdural-puncture-headache/
5. Thakur S, Sharma A, Kaushal S, Sharma A, Sharma N, Thakur PS. Incidence and risk factors of postdural puncture headache in women undergoing cesarean delivery under spinal anesthesia with 26g quincke spinal needle, experience of medical college in rural settings in India 2019: a prospective cohort study design. J Pharm Bioallied Sci. 2022;14:S209–13.
6. Uppal V, Russell R, Sondekoppam R, Ansari J, Baber Z, Chen Y, et al. Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group: A Summary Report. JAMA Netw Open. 2023;6:e2325387. doi: 10.1001/jamanetworkopen.2023.25387.
7. Russell R, Laxton C, Lucas DN, Niewiarowski J, Scrutton M, Stocks G. Treatment of obstetric post-dural puncture headache. Part 1: conservative and pharmacological management. Int J Obstet Anesth. 2019;38:93-103. doi: 10.1016/j.ijoa.2018.12.006.
8. Russell R, Laxton C, Lucas DN, Niewiarowski J, Scrutton M, Stocks G. Treatment of obstetric post-dural puncture headache: part 2—epidural blood patch. Int J Obstet Anesth.2019;38:104-18. doi: 10.1016/j.ijoa.2018.12.005.
9. Peralta F, Devroe S. Any news on the postdural puncture headache front? Best Pract Res Clin Anaesthesiol.2017;31:35-47. doi: 10.1016/j.bpa.2017.04.002.
10. Jespersen MS, Jaeger P, Ægidius KL, Fabritius ML, Duch P, Rye I, et al. Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial. Br J Anaesth. 2020;124:739-47. doi: 10.1016/j.bja.2020.02.025.
11. Piagkou M, Demesticha T, Troupis T, Vlasis K, Skandalakis P, Makri A, et al. The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice. Pain Pract. 2012;12:399-412. doi: 10.1111/j.1533-2500.2011.00507.x.
12. Hung KC, Chen JY, Ho CN, Sun CK. Use of sphenopalatine ganglion block in patients with postdural puncture headache: a pilot meta-analysis. Br J Anaesth. 2021;126:e25-e27. doi: 10.1016/j.bja.2020.10.005.
13. Hara MS, Furuya K, Kishida K, Yamashita S, Kobayashi S, Ogita K. Efficacy and potency of sphenopalatine ganglion block for the management of postdural puncture headaches in post-cesarean section: A case report and literature review. J Obstet Gynaecol Res. 2024;50:2357-2361. doi: 10.1111/jog.16121.
14. Gerbershagen HJ, Rothaug J, Kalkman CJ, Meissner W. Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods. Br J Anaesth.2011:107:619-26. doi:10.1093/bja/aer195.
15. Abouleish E, Vega S, Blendinger I, Tio TO. Long-term follow-up of epidural blood patch. Anesth Analg 1975;54:459-63.
16. Garg S, Sachdeva H. The use of sphenopalatine ganglion block for analgesia and attenuation of stress response induced by skull-pin head-holder during neurosurgery. J Anaesthesiol Clin Pharmacol. 202;36:147-8. doi: 10.4103/joacp.JOACP_134_20.
17. Cohen S, Trnovski S, Zada Y. A new interest in an old remedy for headache and backache for our obstetric patients: a sphenopalatine ganglion block. Anaesthesia. 2001;56:606-7.
18. Schaffer JT, Hunter BR, Ball KM, Weaver CS. Noninvasive sphenopalatine ganglion block for acute headache in the emergency department: a randomized placebo-controlled trial. Ann Emerg Med. 2015;65:503-10. doi: 10.1016/j.annemergmed.2014.12.012.
19. Bornstein NM, Saver JL, Diener HC, Gorelick PB, Shuaib A, Solberg Y, et al. ImpACT-24A Investigators. Sphenopalatine Ganglion Stimulation to Augment Cerebral Blood Flow: A Randomized, Sham-Controlled Trial. Stroke. 2019;50:2108-17. doi: 10.1161/STROKEAHA.118.024582.
20. Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED. Am J Emerg Med. 2015;33 1714.e1-2. doi: 10.1016/j.ajem.2015.03.024.
21. Cohen S, Levin D, Mellender S, Zhao R, Patel P, Grubb W, et al. Topical sphenopalatine ganglion block compared with epidural blood patch for postdural puncture headache management in postpartum patients: a retrospective review. Reg Anesth Pain Med. 2018; 43:880–4. doi: 10.1097/AAP.0000000000000840.
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