title: [Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations].
abstract: BACKGROUND
  Post-dural puncture headache (PDPH) is an important complication of neuroaxial anesthesia and more frequently noted in pregnant women. The pain is described as severe, disturbing and its location is usually fronto-occipital. The conservative treatment of PDPH consists of bed rest, fluid theraphy, analgesics and caffeine. Epidural blood patch is gold standard theraphy but it is an invasive method. The greater occipital nerve (GON) is formed of sensory fibers that originate in the C2 and C3 segments of the spinal cord and it is the main sensory nerve of the occipital region. GON blockage has been used for the treatment of many kinds of headache. The aim of this retrospective study is to present the results of PDPH treated with GON block over 1 year period in our institute.
  
  
  METHODS
  16 patients who had been diagnosed to have PDPH, and performed GON block after caesarean operations were included in the study. GON blocks were performed as the first treatment directly after diagnose of the PDPH with levobupivacaine and dexamethasone.
  
  
  RESULTS
  The mean VAS score of the patients was 8.75 (±0.93) before the block; 3.87 (±1.78) 10min after the block; 1.18 (±2.04) 2h after the block and 2.13 (±1.64) 24h after the block. No adverse effects were observed.
  
  
  CONCLUSIONS
  Treatment of PDPH with GON block seems to be a minimal invasive, easy and effective method especially after caesarean operations. A GON block may be considered before the application of a blood patch.
authors.affiliation: Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ancara, Turquia. Electronic address: esrauyarturkyilmaz@yahoo.com.
authors.forename: Esra
authors.initials: E
authors.lastname: Uyar Türkyilmaz
authors.affiliation: Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ancara, Turquia.
authors.forename: Nuray Camgöz
authors.initials: NC
authors.lastname: Eryilmaz
authors.affiliation: Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ancara, Turquia.
authors.forename: Nihan Aydin
authors.initials: NA
authors.lastname: Güzey
authors.affiliation: Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ancara, Turquia.
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Moraloğlu
keywords: Bloqueio do NOM; Caesarean operations; Cefaleia pós‐punção dural; Cesarianas; GON block; Post‐dural puncture headache