COMPARATIVE STUDY BETWEEN LIDOCAINE 2%, LIDOCAINE 5% AND BUPIVACAINE 0.5% IN TRANSNASAL SPHENOPALATINE GANGLION BLOCK FOR THE TREATMENT OF POSTDURAL PUNCTURE HEADACHE

Hany E. Fares, Salah A. Mohamed, Fawzy A. Badawy, Khaled A. M. Abdelfattah

Abstract


BACKGROUND: Postdural puncture headache (PDPH) is a complication commonly related to neuraxial anesthesia
and dural puncture, with an incidence proportional to the diameter of the needle, ranging from 2% with a 29G to 10% with
a 27G and 25% with a 25G. The development of ne gauge spinal needles and needle tip modication, has enabled a signicant reduction in the
incidence of postdural puncture headache. PDPH presents as a dull throbbing pain with a frontal-occipital distribution. PDPH is thought to be
due to a cerebrospinal uid leak that exceeds the production rate, causing downward traction of the meninges and parasympathetic mediated
reex vasodilatation of the meningeal vessels. The sphenopalatine ganglion (SPG) is an extracranial neural structure located in the
pterygopalatine fossa that has both sympathetic and parasympathetic components as well as somatic sensory roots. Sphenopalatine ganglion
block (SPGB) has been used for the treatment of migraine, cluster headache and trigeminal neuralgia and can be performed through
transcutaneous, transoral or transnasal approaches. Obstetric patients are considered at increased risk for this condition because of their sex,
young age, and the widespread use of neuraxial blocks. SPGB is minimally invasive, carried out at the bedside without using imaging and has
apparently rapid onset than EBP with better safety prole. The most common side effects of SPGB are all temporary, including numbness in the
throat, low blood pressure and nausea.
OBJECTIVES: We evaluated the efcacy and safety of lidocaine 2%, lidocaine 5% and bupivacaine 0.5% in transnasal sphenopalatine
ganglion block for the treatment of post dural puncture headache on 30 patients.
PATIENTS AND METHODS: This prospective, randomized and controlled clinical study was conducted at Sohag University Hospital after
its approval by the Ethics and Research Committee of Sohag Faculty of Medicine. Written informed consent was obtained from each patient
before participation.
RESULTS: Our study showed that there were non signicant differences between the three studied groups regarding age, gender, body mass
index, type of operation, onset, site of headache, associated symptoms, relieving factors and exaggerated follow up. There was a nonsignicant
difference between the three studied groups regarding changes in visual analogue score for severity of headache. There were nonsignicant
differences between the three studied groups regarding presence of bleeding and results of treatment of postdural puncture headache.
CONCLUSION: SPGB is an effective initial modality for managing severe headache in patients with PDPH.


Full Text:

PDF

References


- Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED. Am J Emerg Med, 2015.

- Van Kooten et al. Epidural blood patch in post dural puncture headache: a randomised, observer-blind, controlled clinical trial. J Neurol Neurosurg Psychiatry; 79: 553-558, 2008.

- Kwak K. Treatment of post dural puncture headache . Korean J Anesthesiolv; 70, 2017.

- Nair AS and Rayani BK. Sphenopalatine ganglion block for relieving postdural puncture headache: Technique and mechanism of actionof block with a narrative review of efficacy. Korean JPain; 30(2): 93-97, 2017.

- Cohen S, Sakr A, Katyal S, Chopra D. Sphenopalatine ganglion block for postdural puncture headache. Anaesthesia; 64: 574-5, 2018.

- Khonsary SA, Ma Q, Villablanca P, Emerson J, Malkasian D. Clinical functional anatomy of the pterygopalatine ganglion, cephalgia and related dysautonomias: a review. Surg Neurol Int; 4: S422-8, 2013.

- Schaffer JT, Hunter BR, Ball KM, Weaver CS. Noninvasive sphenopalatine ganglion block for acute headache in the emergency department: a randomized placebo-controlled trial. Ann Emerg Med; 65: 503-10, 2015.

- Puthenveettil N, Rajan S, Mohan A, Paul J, Kumar L. Sphenopalatine ganglion block for treatment of post-dural puncture headache in obstetric patients: An observational study. Indian J Anaesth; 62: 972-7, 2018.

- Patel P, Zhao R, Cohen S, Mellender S, Shah S, Grubb W. Sphenopalatine ganglion block (SPGB) versus epidural blood patch (EBP) for accidental postdural puncture headache (PDPH) in obstetric patients: a retrospective observation. Poster presentation at: 32nd Annual Meeting of the American Academy of Pain Medicine; Palm Springs (CA); Poster #145, 2016.

- Inês Furtado, Isabel Flor de Lima, Sérgio Pedro. Ropivacaine use in transnasal sphenopalatine ganglion block for post dural puncture headache in obstetric patients - case series. Rev. Bras. Anestesiol. vol.68 no.4 Campinas July/Aug, 2018.

- Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anesth; 34: 194-6, 2016.

- Antunes C, Jesus T, Ferreira S, Coutinho A, Magalhaes J. Sphenopalatine Ganglion Block for Postdural Puncture Headache. J Pain Relief; 7: 315, 2018.


Refbacks

  • There are currently no refbacks.