The Effect of Bilateral Nasal Sphenopalatine Ganglion Block in Managing Headaches After Dural Puncture Following Lower Segment Cesarean Section: A Prospective Observational Study

TL;DR

This study shows that a nasal ganglion block works faster than traditional methods for treating headaches after spinal anesthesia during childbirth.

Contribution

Demonstrates the superior efficacy of bilateral nasal sphenopalatine ganglion block over conservative treatment for post-dural puncture headache.

Findings

SPGB onset of analgesia was 15 times faster than conservative treatment.

Only three SPGB-treated patients experienced headache recurrence with VAS score >4.

SPGB is an effective initial treatment for severe post-dural puncture headaches.

Abstract

Background: Post-dural puncture headache (PDPH) is a common complication that occurs in a small percentage of patients who undergo spinal or epidural anesthesia. The current treatment modalities for PDPH involve both conservative management and interventional approaches. In cases where conservative management is ineffective or if the symptoms are severe, interventional treatments are considered. The gold standard treatment for PDPH is the epidural blood patch (EBP). In recent years, minimally invasive interventions such as sphenopalatine ganglion block (SPGB) have been practiced, where a local anesthetic is injected into the sphenopalatine ganglion to block pain signals.

Objective: The primary objective of this study was to study the effectiveness of bilateral intranasal SPGB for the management of PDPH after lower segment cesarean section (LSCS).

Methods: Hundred parturients diagnosed to have PDPH were recruited into this prospective observational study. Patients were allocated to either of the two groups. Descriptive statistics, the chi-squared test, and Student's t-test were used for statistical analysis.

Results: The onset of analgesia in the SPGB group was 15 times faster than that of the conservatively treated control group. There was a reappearance of PDPH with a visual analogue scale(VAS) score >4 in three instances after SPGB.

Conclusion: SPGB is a very effective initial modality for managing severe headaches in patients with PDPH. Our study, beyond a reasonable doubt, indicates the excellent efficacy of SPGB over conservative management alone.

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