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Sphenopalatine Ganglion Block vs Blood Patch for Accidental Post Dural Puncture Headache in Obstetric Patients - A Retrospective Observation
Abstract Number: F-27
Abstract Type: Original Research
Introduction: Postdural puncture headache (PDPH) is a relatively common complication after accidental epidural punctures(EP). Epidural blood patch(EBP), the standard of care for treatment of postdural puncture headache(PDPH) has numerous reports of side effects and complications, including motor and sensory defects, meningitis, seizure and hearing loss. Sphenopalatine Ganglion Block(SPGB) has been applied successfully for headache for more than 100 years without significant side effects. This retrospective study evaluates whether the effectiveness of SPGB for PDPH in obstetric patients was comparable with that of EBP.
Methods: We reviewed 78 records, from the past 15 years, of parturients without the previous history of primary headaches who had experienced the accidental PDPH from a 17g epidural needle. Group I (n=33), patients had SPGB before application of EBP. EBP was available for patients upon request. Cotton tipped applicators saturated in 5% water soluble lidocaine ointment were placed in each nostril for 10 minutes. Group II (n=39), patients had routine EBP for PDPH. Patients were followed up at ½ hr, 1 hr, 24 hr, 48 hr and 1 wk (by phone) increments after treatment.
Results: The two groups had the similar baseline characters, including ASA class, age, height, weight and BMI (p>0.05). At ½ hr after the treatment, 18 of 33 patients (54.55%) who received SPGB had recovered from headache, while 8 of 39 patients (20.51%) who received EBP had recovered from headache (p=2.73 x 10-3). At 1 hr post treatment, 21 of 33 patients (63.64%) with SPGB had recovered from headache versus 12 of 39 patients (30.77%) who with EBP (p=5.29 x 10-3). From 24 hr to 1 wk post treatment, the recovery rate was not significantly different between the two groups. Nine of 33 patients (27.27%) required EBP in SPGB group: 5 patients whose headache resolved ½ hr after the first SPGB, asked for prophylactic EBP to avoid returning with potential headache; 1 patient had headache resolution at 1 hr after the second SPGB also asked for prophylactic EBP; only 3 patients required the EBP for unresolved headache after second SPGB. Thirteen of 33 patients (39.39%) in SPGB group required a second SPGB: 9 patients had unresolved headache, 4 patients without headache feared headache relapse and asked for a second SPGB. Five of 39 patients (12.82%) in EBP group required a second EBP due to the unresolved headache. In SPGB group, no complications or ER visits were reported, while in EBP group, 9 patients had ER visits, 3 patients had backache radiating to the lower extremities, 1 patient had vasovagal reaction and 1 patient had temporary hearing loss that recovered in 30 minutes after the EBP procedure.
Conclusion: SPGB is a highly effective treatment for PDPH in obstetric patients. This is a non-invasive treatment with minimal side effects which relieves headache faster than EBP.
References:  Evans RW. Neurol Clin. 1998 Feb;16(1):83-105.  G S. NY State J Med 1908