title: Ultrasound-guided bilateral greater occipital nerve block for the treatment of post-dural puncture headache.
abstract: OBJECTIVE
  Post-dural puncture headache (PDPH) is one of the complications frequently observed after spinal or epidural anesthesia with dural penetration. For PDPH patients who do not respond to conservative medical treatment, alternative treatments such as bilateral occipital nerve block should be considered.In this study the efficacy of bilateral occipital nerve block was retrospectively evaluated in patients with post-dural puncture headache.
  
  
  METHODS
  Ultrasound-guided bilateral occipital nerve block was administrated in 21 patients who developed PDPH after spinal anesthesia, but did not respond to conservative medical treatment within 48 hours between January 2012 and February 2014. The study was conducted at Erzincan University Faculty of Medicine Gazi Mengucek Education and Research Hospital.
  
  
  RESULTS
  Mean Visual Analog Scale (VAS) pain scores at 10 minutes and 6, 10, 15 and 24 hours after the block were significantly improved compared to the patients with a pre-block VAS score between 4 and 6 as well as patients with a pre-block VAS score between 7 and 9 (p<0.01). After 24 hours of the block applied, VAS pain score dropped to 1 for all 12 patients who had a pre-block VAS score between 4 and 6. Whereas, VAS score decreased to 2 at 24 hours after the block in only one of the patients with a pre-block VAS between 7 and 9. For the patients with a pre-block VAS score between 7 and 9, there was no significant improvement in the mean VAS score 24 hours after the block.
  
  
  CONCLUSIONS
  For patients with PDPH and a pre-block VAS score between 4 and 6 who do not respond to conservative medical treatment, an ultrasound-guided bilateral occipital nerve block may be effective.
authors: Fethi Akyol, M.D. Erzincan University Faculty of Medicine, Gazi Mengucek Education and Research Hospital, Anesthesiology and Reanimation, Erzincan, Turkey.
authors: Fethi
authors: F
authors: Akyol
authors: Orhan Binici, M.D. Erzincan University Faculty of Medicine, Gazi Mengucek Education and Research Hospital, Anesthesiology and Reanimation, Erzincan, Turkey.
authors: Orhan
authors: O
authors: Binici
authors: Ufuk Kuyrukluyildiz, M.D. Erzincan University Faculty of Medicine, Gazi Mengucek Education and Research Hospital, Anesthesiology and Reanimation, Erzincan, Turkey.
authors: Ufuk
authors: U
authors: Kuyrukluyildiz
authors: Guldane Karabakan, M.D. Erzincan University Faculty of Medicine, Gazi Mengucek Education and Research Hospital, Anesthesiology and Reanimation, Erzincan, Turkey.
authors: Guldane
authors: G
authors: Karabakan
keywords: Greater occipital nerve; Post-dural pain headache; Ultrasound