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

Dwivedi, Priyanka; Singh, Pratibha; Patel, Tejas; Bajpai, Vijeta; Kabi, Ankita; Singh, Y. P.; Sharma, Santosh; Kishore, Surekha

doi:10.1016/j.bjane.2023.06.002

Cited by 4 publications

(3 citation statements)

References 47 publications

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“…A recent meta-analysis of randomized controlled trials (including non-obstetric patients) revealed the SPG blockade to be superior to conservative measures concerning short-term pain improvement [36]. Interestingly, carrying out the block within the first 24 h after PDPH diagnosis was found to reduce the risk of symptom recurrence as well as the time to discharge compared to a later treatment.…”

Section: Discussionmentioning

confidence: 99%

Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients

Siegler,

dos Santos Pereira,

Keßler

et al. 2023

Biomedicines

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(1) Background: Postdural puncture headache (PDPH) remains a serious complication in obstetric patients. While the epidural blood patch represents the current gold standard in therapy, a growing number of alternative measures are thought to be beneficial for clinical management. The purpose of this study was to retrospectively analyze the efficacy of intranasal lidocaine administration to treat PDPH in obstetrics at our university hospital; (2) Methods: A retrospective analysis of the medical records of patients with PDPH has been performed focusing on the techniques of administration, dosing, treatment duration, impact on pain intensity as well as side effects of intranasal lidocaine; (3) Results: During the study period, 5610 obstetric patients received neuraxial anesthesia, of whom 43 (0.77%) developed PDPH. About one third of the patients with PDPH after spinal anesthesia (n = 8), epidural anesthesia (n = 5) or both (n = 2) were treated with intranasal lidocaine. Lidocaine was administered either via gauze compresses (GC, n = 4), a mucosal atomization device (MAD, n = 8) or with a second-line mucosal atomization device due to low gauze compress efficacy (n = 3). All patients treated with lidocaine refused the epidural blood patch. Nebulization of lidocaine resulted in a significant reduction in pain intensity after the first dose (p = 0.008). No relevant side effects developed except sporadic temporal pharyngeal numbness. The utilization of the mucosal atomization device averted the necessity for an epidural blood patch, whether employed as the primary or secondary approach; (4) Conclusions: Our data imply that the mucosal atomization device enhances the efficacy of intranasal lidocaine administration in obstetric patients suffering from PDPH.

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Section: Discussionmentioning

confidence: 99%

Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients

Siegler,

dos Santos Pereira,

Keßler

et al. 2023

Biomedicines

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“…Beside the rapidity of pain relief (mean time to onset 12 min), the block significantly increased patient satisfaction [ 45 ]. According to a current meta-analysis of RCTs (investigating both obstetric and nonobstetric PDPH collectives), there is low to moderate evidence suggesting a SPGB superiority over conservative treatment for short-term pain reduction [ 46 ▪▪ ]. Concerning the optimal timing of the procedure, a substantial reduction in hospital length of stay as well as symptom recurrence was demonstrated when the block was conducted within 24 h after PDPH diagnosis compared to later treatment.…”

Section: Therapeutic Managementmentioning

confidence: 99%

“…The current controversy regarding the evidence is emphasized by comparatively moderate effect sizes of the available clinical studies in recent meta-analyses [ 46 ▪▪ ], indicating a summation effect (pain reduction) of <2 after 2 h. Thus, the authors see an indication for SPGB especially in EBP contraindications, whereas when possible, the EBP should not unnecessarily be delayed. A conceivable approach could be to offer SGPB in advance of an EBP to provide a conservative treatment alternative if the response is promising.…”

Section: Therapeutic Managementmentioning

confidence: 99%

Efficacy of therapies for post dural puncture headache

Thon,

Weigand,

Kranke

et al. 2024

Current Opinion in Anaesthesiology

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Purpose of review Clinical management of postdural puncture headache (PDPH) remains an interdisciplinary challenge with significant impact on both morbidity and quality of life. This review aims to give an overview of the most recent literature on prophylactic and therapeutic measures and to discuss novel findings with regard to currently published consensus practice guideline recommendations. Recent findings Although current evidence does not support a recommendation of any specific prophylactic measure, new data is available on the use of intrathecal catheters to prevent PDPH and/or to avoid invasive procedures. In case of disabling or refractory symptoms despite conservative treatments, the epidural blood patch (EBP) remains the therapeutic gold standard and its use should not be delayed in the absence of contraindications. However, recent clinical studies and meta-analyses provide additional findings on the therapeutic use of local anesthetics as potential noninvasive alternatives for early symptom control. Summary There is continuing research focusing on both prophylactic and therapeutic measures offering promising data on potential alternatives to invasive procedures, although there is currently no treatment option that comes close to the effectiveness of an EBP. A better understanding of PDPH pathophysiology is not only necessary to identify new therapeutic targets, but also to recognize patients who benefit most from current treatments, as this might enhance their therapeutic efficacy.

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