Introduction: Post-dural puncture headache is one of the frequently encountered and inevitable post-operative complications of the subarachnoid block. The primary treatment is always considered conservative management in such instances. However, an epidural blood patch remains an invasive gold standard treatment. Sphenopalatine ganglion block is propounded as minimally invasive with prompt and better outcomes. Objective: To assess the efficacy of Sphenopalatine ganglion block (SPGB) when compared to conservative management based on the onset of analgesia and its duration. Methods: This is a prospective study performed on 40 obstetrics patients who underwent Lower segment cesarean section in Lumbini Medical College and Teaching Hospital (LMCTH) who complained of Post dural puncture headache within 7 days. All the parturients are categorized into Group A, those who are treated with sphenopalatine ganglion block, and Group B, where post-dural puncture headache was treated with conservative management. Independent t-tests and Fischer’s test were used for statistical analysis. Results: The patients in group A showed positive outcomes where all of them were relieved of post-dural puncture headache within 10 mins after Sphenopalatine ganglion block (p<0.001) and the mean pain score, based on a numerical pain rating scale was less or equal to 4 for the first 8 hours. Conclusions: Sphenopalatine ganglion block (SPGB) could be used as an effective first-line treatment modality in the management of post-dural puncture headache compared to conservative management.

Introduction: Spinal anesthesia has offered a new armamentarium for the anesthesiologists and has been widely used in the Cesarean section in the field of obstetrics, an alternative to general anesthesia. However, Post Dural Puncture Headache remains an inevitable complication of spinal anesthesia and can be minimized its incidence by reducing the size of the needle and changing the design of the needle tip.  The objective of the study was to find the incidence of post-dural puncture headache undergoing subarachnoid block for CS using 25G Quincke and 25G Whitacre needles. Materials and methods: This study was conducted from August 2020 to January 2021 enrolling 72 parturients and were allocated in two groups of 36 each. Group A and B parturients received spinal anesthesia via. 25G Quincke and 25G Whitacre in sitting position respectively. All the patients were evaluated based on incidence, onset, duration, and severity of headache postoperatively for 72 hours after the subarachnoid block. Results: The incidence of post-dural puncture headache in the study was 7.2% in Group A and 3.15% in Group B which was statistically significant (P-value = 0.011), while there were no significant differences between these two groups in the onset, severity, and duration of post-dural puncture headache. Conclusion: Despite no significant differences were found for the onset, severity, and duration of post-dural puncture headache, the use of 25G Whitacre is associated with a reduced incidence of post-dural puncture headache compare to 25G Quincke.

Background: Pain on intravenous injection of propofol is seen in almost 70% of patients without any pretreatments. This study was conducted to evaluate the effect of ondanse­tron in reducing the occurrence of pain on intravenous injection of propofol. Methods: Two hundred and thirty-two patients aged between 18- 60 years of either sex belong­ing to ASA status I and II, scheduled for laparoscopic cholecystectomy under general anesthesia at Chitwan Medical College, Bharatpur, Nepal, from from September 1, 2020 to March 31, 2021 were recruited in this study. They were assigned randomly into two groups with 116 participants in each, where Group 1 received 2 ml (4 mg) of ondansetron and Group 2 received 2 ml of 0.9% saline (placebo) intravenously as the pretreatment solution prior to injection of propofol for induction of general anesthesia. The overall incidence of pain in the saline group was 84.5% compared to 48.3% in the ondansetron group (P < 0.001). Result: Pain was of mild intensity in most patients who belonged to the ondansetron group (33.6%) whereas it was of moderate intensity in most participants of the saline group (54.3%). Few patients in the study group experienced severe pain (0.9%) as compared to the placebo group (9.5%) with P < 0.001. Conclusion: Therefore, it was concluded that pretreatment with ondansetron may be a useful intervention in reducing the incidence of pain on intravenous propofol administration without any adverse effects in significant number of patients.