Ultrasound-Guided Suprazygomatic Sphenopalatine Ganglion Block for Postdural Puncture Headache Resistant to Epidural Blood Patch: A Case Report

Abstract

Even though epidural blood patch (EBP) is thought to be the definitive treatment for severe cases of postdural puncture headache (PDPH), it may be accompanied by complications like adhesion arachnoiditis, and cauda equina syndrome, especially if the injection is repeated. The sphenopalatine ganglion (SPG) block is a new minimally invasive technique for the treatment of PDPH, with variable results according to the clinical situation and deployed approach. We describe a case of PDPH resistant to EBP in which we successfully managed symptoms using ultrasound-guided suprazygomatic SPG block to deliver local anesthetic directly into pterygopalatine fossa, thus avoiding a second EBP.

Postdural Puncture Headaches in Pediatric Patients: A Review of Options When Repeated Epidural Blood Patches Do Not Work

“…Several modifications of the SPG method have been proposed to improve the delivery of local anesthetic closer to the SPG, such as hollow-bore cotton swabs [15] and a J-tip catheter [16] to deliver the local anesthetic closer to the SPG. Another recent case report describes the successful treatment of a resistant PDPH to EBP with a suprazygomatic SPG block [17]. The SPG was targeted via the suprazygomatic approach, utilizing a 22G spinal needle directed toward the pterygopalatine fossa with ultrasound guidance.…”