title: Greater occipital nerve block for postdural puncture headache (PDPH): a prospective audit of a modified guideline for the management of PDPH and review of the literature.
abstract: OBJECTIVE
  To perform a prospective audit of the modified guideline for the management postdural puncture headache (PDPH) and present the results at 6 months.
  
  
  METHODS
  Prospective single-center audit.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  24 adult, ASA physical status 1, 2, and 3 patients presenting with PDPH in both the obstetric and nonobstetric setting.
  
  
  METHODS
  Epidural blood patch (EBP) and bilateral greater occipital nerve blocks (GONB) were administered.
  
  
  METHODS
  Headache scores, nausea scores, presence and severity of neck stiffness, tinnitus, photophobia, and any complications with either technique.
  
  
  RESULTS
  24 patients were audited. Nineteen patients failed conservative management and were offered both GONB and EBP. One patient chose the EBP and was successfully treated. Of the 18 patients who received the GONB, headache resolved in 12 patients (66%). Six patients had a partial response to nerve block and were treated with an EBP.
  
  
  CONCLUSIONS
  Greater occipital nerve block with dexamethasone may have a role in the management of patients presenting with PDPH, who have failed conservative management. We present the results of our prospective audit and review the literature on GONB in the management of PDPH.
authors.affiliation: Department of Anaesthesia and Pain Management, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK. Electronic address: nirajgopinath@yahoo.co.uk.
authors.forename: G
authors.initials: G
authors.lastname: Niraj
authors.affiliation: Department of Anaesthesia and Pain Management, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
authors.forename: Aditi
authors.initials: A
authors.lastname: Kelkar
authors.affiliation: Department of Anaesthesia and Pain Management, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK.
authors.forename: Vandana
authors.initials: V
authors.lastname: Girotra
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage; D017217:Blood Patch, Epidural; D004739:England; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008485:Medical Audit / Q000379:methods; D009407:Nerve Block / Q000379:methods* / Q000592:standards; D051299:Post-Dural Puncture Headache / Q000209:etiology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: Greater occipital nerve block; Postdural puncture headache