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

Puthenveettil, Nitu; Rajan, Sunil; Mohan, Anish; Paul, Jerry; Kumar, Lakshmi

doi:10.4103/ija.ija_443_18

Cited by 37 publications

(16 citation statements)

References 24 publications

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“…Moreover, both approaches are less invasive and safer than EBP [ 39 ]. Two Indian publications support SPG block as a good alternative modality in treating PDPH [ 40 , 41 ]. A single-blinded randomized study highlighted that the applicator technique of a trans-nasal SPG block produces superior pain alleviation compared to the nasal spray approach [ 42 ].…”

Section: Reviewmentioning

confidence: 99%

Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review

Alatni,

Alsamani,

Alqefari

2024

Cureus

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Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. The treatment and prevention options for PDPH differ widely from one institution to another. The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. This study aimed to summarize all articles published during the past decade that discussed the treatment or prevention of PDPH. From 2013 to 2023, 345 publications were filtered for all treatment and prevention approaches used for PDPH patients. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines were followed for conducting this systematic review, and 38 articles were included for analysis and review. Existing data come from small randomized clinical trials and retrospective or prospective cohort studies. This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results. Consequently, the use of neuraxial morphine or epidural dexamethasone for the prevention of PDPH remains questionable. Regarding the posture of the patient and its consequences on the incidence of the headache, lateral decubitus is better than a sitting position, and a prone position is better than a supine position. Smaller non-cutting needles play a role in avoiding PDPH. Minimally invasive nerve blocks, including sphenopalatine ganglion or greater occipital nerves, are satisfyingly effective. Epidural blood patches remain the more invasive but the gold standard and ultimate solution in patients resisting medical therapy. This study highlights the need for larger research to define the best approach to prevent and treat PDPH.

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Section: Reviewmentioning

confidence: 99%

Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review

Alatni,

Alsamani,

Alqefari

2024

Cureus

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“…д.) [21,22] или же другой местный анестетик [23]. Оставшиеся 5 исследований [8][9][10][11][12], которые соответствовали критериям включения и исключения, составили основу данного метаанализа.…”

Section: результаты отбор исследованийunclassified

“…Юрьева, Д.В. Заболотский Эффективность применения крылонебной блокады с целью обезболивания у взрослых: систематический обзор и метаанализ В нашем исследовании отсутствие плацебо в группах сравнения или сочетание КНБ с другим периферическим блоком в некоторых исследованиях сделало невозможным включение их в метаанализ и статистическую обработку [15,[21][22][23]38]. Тем не менее хотелось бы остановиться на результатах данных публикаций подробнее.…”

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“…Около 88,89% пациентов в группе с КНБ получили адекватное обезболивание в течение 5 минут после блока (P < 0,001). Обезболивающий эффект был более выражен и сохранялся до 8 часов без каких-либо побочных явлений [22]. D. L. Kirkpatrick и соавт.…”

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The Analgetic Efficacy of Pterygopalatine Blockade for Pain Treatment in Adults: a Systematic Review and Meta-Analysis

Oleshchenko

Юрьева

Заболотский

2023

Kuban. nauсh. med. vestnik

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Background. The use of regional blockades for the purpose of analgesia is widely used in all fields of medicine, however, the analgesic efficacy of the pterygopalatine blockade, as an independent method of treating pain of various genesis, has not been studied enough. Therefore, there is a need to analyze the results of clinical trials to evaluate the analgesic efficacy of the pterygopalatine blockade as an independent method of anesthesia.Objective — to investigate the analgesic effect of pterygopalatine blockade as a monotherapy in patients with pain of various origins of oculotemporal area, conducting a meta-analysis of published results of randomized clinical trials.Methods. The methodology involved a systematic literature search by means of PubMed, MEDLINE, EMBASE, and Cochrane Library search engines. The search covered the period of the past 10 years and had the following criteria: a double-blind, randomized, controlled study of the use of pterygopalatine blockade with a local anesthetic versus placebo. For each included study, a standardized magnitude of the analgesic effect of pterygopalatine blockade compared to placebo was calculated, with pain assessing in 15, 30, and 60 minutes after the blockade was performed. Meta-analyses were conducted for each endpoint. Meta-analysis was performed using Stata 11.0 application programs ((The Cochrane Collaboration, Oxford, United Kingdom).Results. Five randomized controlled trials involving 269 patients met the inclusion criteria, and involved analyzing the pterygopalatine blockade with local anesthetic (n=140) against placebo (n=129). In 15 minutes after pterygopalatine blockade was performed, the difference in mean pain intensity compared to the control group was -2.5 points, the mean level was lower in the pterygopalatine blockade group, MD=-2.5 [95% CI -3.7; -1.7]. After 30 minutes: -2.7 points, MD=-2.7 [95% CI -4.5; -1.5], after 60 minutes: -1.7 points, MD=-1.7 [95% CI -4.0; -0.5]. The relative risk of adverse effects, such as nasopharyngeal symptoms, after performing a pterygopalatine blockade with a local anesthetic accounted for (RR =1.31 [95% CI 0.5–3.04]). In this regard, the incidence of complications and their variants that can be caused by pterygopalatine blockade is a matter for further clinical research.Conclusion. The results obtained in the meta-analysis testify to the analgesic effect of the pterygopalatine blockade as a monotherapy in patients with pain of different origins oculotemporal area in 15, 30, and 60 minutes after its performance. These data may be relevant when choosing a method for first-line anesthetic management of pain syndrome of oculotemporal area.

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“…Published data on the effectiveness in alleviating PDPH is very limited. Several small trials have demonstrated positive results for the SPG block in treating PDPH [59][60][61][62][63]. However, a 2020 randomized controlled trial (RCT) found no difference between SPG block and sham block both seemed to reduce the overall pain score and need for EBP [64].…”

Section: Peripheral Nerve Blockadementioning

confidence: 99%

Etiology, management, and sequela of postdural puncture headache

Taraskiewicz

Sheeran

Marco

et al. 2023

Current Opinion in Anaesthesiology

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Purpose The purpose of this article is to provide readers with a concise overview of the cause, incidence, treatment of, and sequalae of postdural puncture headaches (PDPH). Over the past 2 years, much data has been published on modifiable risk factors for PDPH, treatments for PDPH, and sequalae of PDPH particularly long-term. Recent findings There is emerging data about how modifiable risk factors for PDPH are not as absolute as once believed. There have been several new meta-analysis and clinical trials published, providing more data about effective therapies for PDPH. Significantly, much recent data has come out about the sequalae, particularly long-term of dural puncture. Summary Emerging evidence demonstrates that in patients who are at low risk of PDPH, needle type and gauge may be of no consequence in a patient developing a PDPH. Although epidural blood patch (EBP) remains the gold-standard of therapy, several other interventions, both medical and procedural, show promise and may obviate the need for EBP in patients with mild–moderate PDPH. Patients who endure dural puncture, especially accidental dural puncture (ADP) are at low but significant risk of developing short term issues as well as chronic pain symptoms.

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

Cited by 37 publications

References 24 publications

Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review

Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review

The Analgetic Efficacy of Pterygopalatine Blockade for Pain Treatment in Adults: a Systematic Review and Meta-Analysis

Etiology, management, and sequela of postdural puncture headache

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