ESRA19-0386 Transnasal sphenopalatine ganglion block for treatment of postdural puncture headache in obstetric patients. (30th August 2019)

• Record Type: Journal Article
• Authors: Viegas Ribeiro, M; Pacheco, J; Lança, F
• Is Part Of: Regional anesthesia and pain medicine. Volume 44(2019)Supplement 1
• Page Start: A191
• Page End: A191
• Publication Date: 2019-08-30
• Subjects: Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1136/rapm-2019-ESRAABS2019.320
• Languages: English
• ISSNs: 1098-7339

Abstract

Abstract : Background and aims: Sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. It has been used for treating headaches of multiple etiologies. These two cases comprise SPG block used to treat postdural puncture headache (PDPH) in postpartum patients. Methods: We performed a transnasal SPG block using a cotton-tipped applicator and 2% lidocaine. Pain assessment was performed using the numeric rating scale and it was made before performing the technique and at 0h, 2h, 6h, 12h, 24h and 48h after the block. Results: Two women, ages 30 and 27 years, developed PDPH after spinal analgesia using a 27G and a 25G Quincke needle, respectively. Before the treatment they described 9/10 and 10/10 pain, and after both of them reported significant pain relief within the first 5 minutes. A high degree of pain relief was sustained throughout the first 24 hours post-treatment; however, after this period there was a recurrence of pain, although less intense (8/10). In both patients an epidural blood patch (EBP) was performed after recurrence of pain, which provided symptomatic relief, allowing discharge after 24 hours. Conclusions: Transnasal SPG block is a safe and easy technique with fewer complications than EBP. Given the cases described, it allows a good analgesic control, however, its effect is limited in time, being necessary its reapplication. Since PDPH is self-limited with spontaneous resolution in most cases, the blockade could be done serially until the resolution of the condition, avoiding more invasive techniques with higher risk of severe complications such as the EBP.