Efficacy and efficiency of sphenopalatine ganglion block for management of post-dural puncture headache in obstetric patients: a randomized clinical trial

Abstract

Background This clinical trial aimed to study the efficacy and efficiency of sphenopalatine ganglion block (SPGB) for the management of post-dural puncture headache (PDPH) in obstetric patients. A prospective randomized clinical trial was carried out on 40 patients with PDPH divided randomly into two equal groups. Paracetamol group (PG): The patients received 1 g of paracetamol three times per day intravenously for 1 day. If adequate pain relief was not achieved, rescue analgesia in the form of intravenous ketorolac was given. Block group (SPGBG): The patients received bilateral SPGB using 3 ml mixture of lignocaine with dexamethasone in each nostril. The pain score, heart rate, and mean arterial pressure were recorded. The onset of analgesia, duration of analgesia, adverse effects, total dose of ketorolac, patient satisfaction, and hospital stay for epidural blood patch (EBP) or hospital discharge after 24 h were also documented. Results The pain perception (numeric rating scale [NRS]) in the block group was generally lower throughout the study showing only highly significant difference till the first 2 h after the block with more rapid onset and longer duration of analgesia. The total dose of rescue analgesic in mg was significantly lower in the block group and hospital stay for EBP was significantly less in the block group with higher patient satisfaction. Conclusions PDPH can be treated effectively and rapidly with transnasal SPGB, which is a noninvasive, safe, and easy method with a low complication rate. Trial registration ClinicalTrials.gov, NCT04793490. Registered on March 11, 2021; https://clinicaltrials.gov/ct2/show/NCT04793490).

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

“…1 ). 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 Among the included studies, eight studies performed bilateral SPG block and one study. 37 assessed unilateral SPG block.…”

“… 37 assessed unilateral SPG block. The block was performed using lidocaine 2%, 34 , 35 , 36 , 38 4% 30 , 31 , 32 , 33 and 10% 37 along with ropivacaine 0.5% 32 or dexamethasone 4 mg 34 , 38 or adrenaline 1/2000000. 30 Among 9 included studies, there were 4 different modalities of interventions in the control group: sham SPG block using saline, 32 SPG block with 2 puffs of intranasal lidocaine 10%, 35 bilateral GON block, 38 and conservative measures which included noninvasive pharmacological methods (acetaminophen, diclofenac, tramadol, magnesium sulfate, theophylline, codeine and caffeine in various combinations along with intravenous fluids, abdominal binders and bedrest in 6 studies).…”

“… 30 Among 9 included studies, there were 4 different modalities of interventions in the control group: sham SPG block using saline, 32 SPG block with 2 puffs of intranasal lidocaine 10%, 35 bilateral GON block, 38 and conservative measures which included noninvasive pharmacological methods (acetaminophen, diclofenac, tramadol, magnesium sulfate, theophylline, codeine and caffeine in various combinations along with intravenous fluids, abdominal binders and bedrest in 6 studies). 30 , 31 , 33 , 34 , 36 , 37 Regarding the dural puncture proceeding the PDPH, all studies included patients developing PDPH after spinal anesthesia except 31 Bohara et al and Jespersen et al 32 who included patients developing a headache after lumbar puncture and epidural anesthesia. The surgical procedure in 6 studies 31 , 34 , 35 , 36 , 37 , 38 was Lower Segment Cesarean Section (LSCS), while 3 studies included patients with various surgeries and procedures conducted under spinal anesthesia.…”

“… 30 , 31 , 33 , 34 , 36 , 37 Regarding the dural puncture proceeding the PDPH, all studies included patients developing PDPH after spinal anesthesia except 31 Bohara et al and Jespersen et al 32 who included patients developing a headache after lumbar puncture and epidural anesthesia. The surgical procedure in 6 studies 31 , 34 , 35 , 36 , 37 , 38 was Lower Segment Cesarean Section (LSCS), while 3 studies included patients with various surgeries and procedures conducted under spinal anesthesia. 30 , 32 , 33 Two studies reported pain score data in median (interquartile range).…”

“… 30 , 32 , 33 Two studies reported pain score data in median (interquartile range). 30 , 34 One study used median (range) to report pain score data. 32 These outcome data were calculated to mean (standard deviation) using the online tool.…”