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Sphenopalatine ganglion block for obstetric post-dural puncture headache: A case series
Abstract Number: T4A-3
Abstract Type: Original Research
At our institution obstetric patients who present with a post-dural puncture headache (PDPH) are offered either an epidural blood patch (EBP) or a sphenopalatine ganglion block (SPGB) or both. The risk of inadvertent dural puncture in an obstetric patient undergoing a labor epidural is 0.04-6%.1
Strict bed rest and fluid hydration have not been proved to be effective treatments.2 Caffeine is effective when compared to placebo at relieving PDPH and those patients are less likely to require an intervention.3 An EBP, the current gold standard treatment for PDPH, improves symptoms on the first attempt 61-98% of the time, however the procedure is associated with many risks.4 We propose that a SPGB is a relevant, non-invasive alternative or adjunct procedure to an EBP in the management of PDPH in an obstetric patient.
After IRB approval, we reviewed obstetric SPGB data from January 1st, 2017 to November 7th, 2017. A SPGB is non-invasive, and has minimal side effects. Ten patients received a SPGB to treat PDPH. A simple nasal block was performed using Q-tips soaked in 4% Lidocaine. The applicators were saturated with 1-3 mL of 4% Lidocaine and placed into each nare at the posterior nasopharynx. Additionally, 1.5mL of 4% Lidocaine was injected into the hollow applicator. The cotton tip applicators are left in place for 10 minutes and then removed. The effect was immediate with improved reported pain scores in all ten patients. Pain relief was variable in duration with six patients requiring an additional SPGB. The SPGB relieved symptoms altogether for three patients. Seven women requested a subsequent EBP. All women including those who went on to have an EBP recommended having a SPGB. A SPGB improved patient satisfaction.
We propose that women diagnosed with a PDPH should be offered a SPGB prior to an EBP. In our case series, three women did not require a further EBP thus avoiding associated procedural risks and saving anesthesiology time, personnel and equipment.
1. Berger CW, et al. Can J Anaesth, 1998.
2. Arevalo-Rodriguez I, et al. Cochrane Database Syst Rev. 2016. 3. Basurto OX, et al. Cochrane Database Syst Rev. 2015.
4. Kwak HK. Korean J Anesthesiol. 2017.