Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients.
OBJECTIVE
To demonstrate a possible alternative treatment for postdural puncture headache (PDPH).


METHODS
Postdural puncture headache is a common complication associated with neuraxial anesthesia and unintentional dural puncture. Epidural blood patch (EBP) is the standard therapy for PDPH but has risks including pain, dural puncture, and infection. Transnasal sphenopalatine ganglion block (SPGB) has been successfully used to treat migraine, cluster headache, and trigeminal neuralgia. This is a small case series in which SPGB was used to treat PDPH in 3 obstetric patients.


METHODS
Labor and delivery suite.


METHODS
Three postpartum patients with PDPH were studied. One patient was American Society of Anesthesiologists physical status 1, and the other 2 were American Society of Anesthesiologists physical status 2.


METHODS
Transnasal SPGB using cotton-tipped applicators and 2% viscous lidocaine was performed on all 3 patients.


METHODS
Height, weight, and vital signs were measured on all patients. In addition, the numeric rating scale (0-10) was used to quantify the pain level while in the sitting position preprocedure, immediately postprocedure, 24 hours postprocedure, and 48 hours postprocedure.


RESULTS
All 3 patients had significant pain relief following the SPGB without the need for EBP.


CONCLUSIONS
When comparing the risks of a transnasal SPGB, which include bleeding and temporary discomfort, against those of an EBP, which are documented as dural puncture, neurologic complications, bleeding, and infection, it seems reasonable to offer the SPGB before EBP.
Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR. Electronic address: skent@uams.edu.
Sheffield
S
Kent
Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR. Electronic address: grmehaffey@uams.edu.
Gregory
G
Mehaffey
D000281:Administration, Intranasal; D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage; D017217:Blood Patch, Epidural / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D051299:Post-Dural Puncture Headache / Q000628:therapy*; D011247:Pregnancy; D059387:Sphenopalatine Ganglion Block / Q000009:adverse effects / Q000379:methods*; D013129:Spinal Puncture / Q000009:adverse effects*; D055815:Young Adult
D000779:Anesthetics, Local; D008012:Lidocaine
Postdural puncture headache; Sphenopalatine ganglion block