Comparison Between Sphenopalatine Ganglion Block And Greater Occipital Nerve Block in the Management of Post-Dural Puncture Headache in Patients Refractory to Oral Therapy

Awais Khalid; Ahmed Mujadid Khan Burki; Ruhullah; Mustafa Bhutta; Muhammad Tayyab; Moin Iqbal

doi:10.51253/pafmj.v76i5.13253

Authors

Awais Khalid Department of Anaesthesiology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Ahmed Mujadid Khan Burki Department of Anaesthesiology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Ruhullah Department of Anaesthesiology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Mustafa Bhutta Department of Anaesthesiology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Muhammad Tayyab Department of Anaesthesiology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Moin Iqbal Department of Anaesthesiology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i5.13253

Keywords:

Greater occipital nerve block; post-dural puncture headache; sphenopalatine ganglion block

Abstract

Objective: To compare the efficacy of sphenopalatine ganglion block with greater occipital nerve block in the management of post-dural puncture headache in obstetric patients after cesarean section under spinal anesthesia.

Study Design: Quasi-experimental study

Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital, Rawalpindi, Pakistan, Sep 2024 to Feb 2025.

Methodology: Patients in Group-S (n=70) received the sphenopalatine nerve block (SPNB) and patients in Group-G (n=70) received the greater occipital nerve block (GONB). Primary variables studied were median numeric rating scale (NRS) scores for pain (0-100) (0-No Pain to 100-Maximum pain imaginable) assessed at 1,6,12 and 24 hours between both groups, the total dose of rescue analgesia, the frequency of patients requiring epidural blood patch and patient satisfaction on the Likert scale.

Results: Median NRS scores before intervention between both groups were 45.00 (5.00) in Group-S versus 45.00 (5.00) in Group-G (p=0.875). Same scores assessed after 01 hour were 40.00 (5.00) versus 40.00 (5.00) between both groups (p=0.880). Assessment after 06 hours showed median scores of 30.00 (5.00) in Group-S versus 30.00 (9.00) in Group-G (0.650). After 12 hours, median scores were 15.00 (5.00) versus 25.00 (0.00) between both groups (p<0.001), and assessment after 24 hours showed median scores of 15.00 (0.00) in Group-S versus 20.00 (10.00) in Group-G (p<0.001).

Conclusion: It was concluded that sphenopalatine block offers better pain scores and patient satisfaction with reduced need for rescue analgesia, with both blocks offering good results with minimal side effects.

Downloads

Download data is not yet available.

References

1. Dohlman LE, Kwikiriza A, Ehie O. Benefits and barriers to increasing regional anesthesia in resource-limited settings. Local Reg Anesth 2020; 13: 147-158.

https://doi.org/10.2147/LRA.S236550

2. Iddrisu M, Khan ZH. Anesthesia for cesarean delivery: general or regional anesthesia—a systematic review. Ain Shams J Anesthesiol 2021; 13(1): 3.

https://doi.org/10.1186/s42077-020-00121-7

3. Al-Husban N, Elmuhtaseb MS, Al-Husban H, Nabhan M, Abuhalaweh H, Alkhatib YM, et al. Anesthesia for cesarean section: retrospective comparative study. Int J Womens Health 2021; 13: 141-152.

https://doi.org/10.2147/IJWH.S292434

4. Al-Hashel J, Rady A, Massoud F, Ismail II. Post-dural puncture headache: a prospective study on incidence, risk factors, and clinical characterization of 285 consecutive procedures. BMC Neurol 2022; 22(1): 261.

https://doi.org/10.1186/s12883-022-02785-0

5. Costa AC, Satalich JR, Al-Bizri E, Shodhan S, Romeiser JL, Adsumelli R, et al. A 10-year retrospective study of postdural puncture headache in 32,655 obstetric patients. Obstet Anesth Dig 2020; 40(4): 169-170.

https://doi.org/10.1097/01.aoa.0000719424.77657.5c

6. Lakhe G, Shrestha P, Duwadi V. Postdural puncture headache after spinal anaesthesia in parturients undergoing cesarean section in the department of anesthesia in a tertiary care center: a descriptive cross-sectional study. JNMA J Nepal Med Assoc 2023; 61(261): 417-420.

https://doi.org/10.31729/jnma.8140

7. Smita S, Dubey PK, Singh K. Intranasal sphenopalatine ganglion block by lignocaine spray for postdural puncture headache following spinal anesthesia: a randomized clinical trial. Anaesthesiol Intensive Ther 2023; 55(1): 16-20.

https://doi.org/10.5114/ait.2023.132524

8. Patel R, Urits I, Orhurhu V, Orhurhu MS, Peck J, Ohuabunwa E, et al. A comprehensive update on the treatment and management of postdural puncture headache. Curr Pain Headache Rep 2020; 24(6): 24.

https://doi.org/10.1007/s11916-020-00860-0

9. Shin HY. Recent update on epidural blood patch. Anesth Pain Med 2022; 17(1): 12-23. https://doi.org/10.17085/apm.21113

10. Youssef HA, Abdel-Ghaffar HS, Mostafa MF, Abbas YH, Mahmoud AO, Herdan RA. Sphenopalatine ganglion versus greater occipital nerve blocks in treating post-dural puncture headache after spinal anesthesia for cesarean section: a randomized clinical trial. Pain Physician 2021; 24(4): E443-E451.

11. Abdelrazik RA, Toulan HF, Ayoub SNB. Sphenopalatine ganglion block vs greater occipital nerve block in the management of post-dural puncture headache in obstetric patients: a randomized clinical trial. Anaesth Pain Intensive Care 2024; 28(1): 68-73. https://doi.org/10.35975/apic.v28i1.2143

12. Hasoon J, Urits I, Rana AJ, Burroughs M, Cai V, Viswanath O, et al. Long-term outcomes of post-dural puncture headache treated with epidural blood patch: a pilot study. Psychopharmacol Bull 2020; 50(4 Suppl 1): 25-33. https://doi.org/10.64719/pb.4379

13. Rahman K, Adetona T, Olasunkanmi I, Olasupo D, Adeniji M, Peleowo H, et al. Lived experiences of mothers with/without post dural puncture headache and its effects on early initiation of breastfeeding at Federal Medical Centre, Abeokuta, Nigeria. Midwifery 2024; 7(1): 1-14.

https://doi.org/10.52589/AJHNM-I9KM2OIF

14. Bateman BT, Cole N, Sun-Edelstein C, Lay CL. Post-dural puncture headache. UpToDate [Internet]. Waltham (MA): UpToDate; 2021. Available from: https://www.uptodate.com/contents/post-dural-puncture-headache

15. Tutar M, Korucu D, Ciftci C, Kozanhan B. The relationship between serum estrogen concentration and post-dural puncture headache: a retrospective study. Eur Rev Med Pharmacol Sci 2023; 27(6): 2274-2280.

https://doi.org/10.26355/eurrev_202303_31766

16. Tubben RE, Jain S, Murphy PB. Epidural blood patch. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK470332/

17. Khan A, Feroz SH, Iqbal S, Sultan M, Munir S, Ahmed W. Comparison of sphenopalatine block and intravenous paracetamol for the treatment of post-dural puncture headache. Pak Armed Forces Med J 2022; 72(3): 1136-1139.

https://doi.org/10.51253/pafmj.v72i3.7533

18. Elsayed AA, Elsawy TTD, Rahman AEA, Arafa SKH. Bilateral greater occipital nerve block; distal versus proximal approach for postdural puncture headache: a randomized clinical trial. Pain Physician 2023; 26(5): 475-483.