Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients

Study objective: To demonstrate a possible alternative treatment for postdural puncture headache (PDPH).

Design: 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.

Setting: Labor and delivery suite.

Patients: 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.

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

Measurements: 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.

Main 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.