Transnasal Sphenopalatine Ganglion Block for Management of Postdural Puncture Headache in Non-Obstetric Patients

Abstract

Background: This study investigated the efficacy and safety of transnasal sphenopalatine ganglion block (SPGB) for treatment of postural puncture headache (PDPH) in non-obstetric patients.Methods: This retrospective study was conducted at the Ankara Research and Educational Hospital, in Turkey, and included 26 non-obstetric patients (age, "18 years) who were diagnosed with PDPH and unresponsive to conservative therapy or unable to continue it because of side effects. Transnasal SPGB was performed in each nostril. Pain severity was assessed with the Visual Analogue Scale (VAS) at 15 min, 30 min, 24 h, and 48 h after the procedure, while patients were seated. The patients were monitored for 48 h for adverse effects (AEs). Patient treatment satisfaction was assessed at 48 h after the procedure by using the Patient Global Impression of Change (PGIC) scale.Results: Headache at 15 min post-procedure was relieved rapidly. At 24 h post-procedure, nearly half of patients (42.3%) had no pain, and all patients (100%) had a VAS score of <3. Nasal discomfort, throat numbness, and nausea were AEs reported after SPGB; however, these AEs were completely relieved at 24 h after the procedure. According to the PGIC scale scores at 48 h post-procedure, 73.1% of patients evaluated themselves as "much improved" and 26.9% evaluated themselves as "very much improved". Conclusion:When PDPH does not respond to conservative treatment, it may be treated effectively with transnasal SPGB, which is a noninvasive, safe, well-tolerated, and straightforward method with a low complication rate.

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

“…These findings highlight trends for faster relief from headache after block. 39 Similar findings were reported in previous retrospective studies comparing SPG block with EBP 18 , 19 , 40 where effective pain relief was noted within 30 min of a block. In our analysis, no significant difference was observed for later time intervals (6 h, 8 h, 12 h, 24 h, and 7 days), which is in line with previous studies.…”

“…SPG is considered a target in the management of various headache disorders. 14 , 15 SPG block for managing PDPH was first published by Cohen et al in 2001 16 and subsequently, various case reports, case series, retrospective and observational studies reported the efficacy of this superficial, noninvasive, and technically simple block for successful pain relief in PDPH 17 , 18 , 19 although the results were inconclusive due to the paucity of reviews and lack of evidence. 20 An earlier pilot meta-analysis of observational studies found no significant therapeutic advantage over conventional treatments.…”

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

“…Cohen et al (Cohen et al 2018) and Puthenveettil et al (Puthenveettil et al 2018) stated that in their studies, patients had no side effects related to the block. Takmaz et al (Takmaz et al 2021) documented that nasal discomfort, throat numbness, and nausea were reported after SPGB, all completely resolved by 24 h after the procedure. Almost most studies (Cohen et al 2009(Cohen et al , 2001Jespersen et al 2020) showed a reduction in the need for EBP with overall high patient satisfaction.…”

“…Takmaz et al (Takmaz et al 2021) in their study included 26 non-obstetric patients with PDPH. They found that PDPH was rapidly relieved after receiving transnasal SPGB, and the treatment effect lasted for 48 h after the procedure in all patients.…”

“…Only few studies have investigated the efficacy and safety of SPGB for treating the PDPH. Earlier studies showed that SPGB was a safe procedure, provided good pain relief after the block, and showed reduction in the need for EBP with overall high patient satisfaction (Candido et al 2013;Cohen et al 2018Cohen et al , 2009Cohen et al , 2001Jespersen et al 2020;Mehaffey 2015, 2016;Patel et al 2016;Puthenveettil et al 2018;Santos et al 2021;Takmaz et al 2021). All these studies were suggestive that the block could be useful.…”