Sphenopalatine Ganglion Block for Postdural Puncture Headache

Abstract

Post-dural puncture headache (PDPH) is a relatively common complication associated with neuraxial anesthesia and unintentional dural puncture. Epidural blood-patch (EBP) is the gold standard treatment when conservative therapy fails, but has significant risks associated. Recently, bilateral sphenopalatine ganglion block (SPGB) has emerged as an alternative and safe technique in patients with PDPH. Although, there are still few cases reported in the literature. The authors describe two cases of PDPH with resolution after performance of bilateral SPGB. Case 1: Male, submitted to knee arthroplasty under a combined neuraxial anesthesia, with accidental dural puncture with a Tuohy needle. On the third postoperative day, the patient reported frontal headache, exacerbated by orthostatism. The authors performed a bilateral transnasal SPGB and the patient reported clinical improvement, being discharged the next day without any symptoms. Case 2: Pregnant in labor. Epidural space approach with accidental dural puncture. On the second day postpartum, she started with PDPH symptoms, being decided conservative treatment. Two days later, the authors opt to perform a bilateral SPGB. After that, the puerpera has complete relief, being discharged 24 hours later. SPGB, although widely described in the control of headache in the context of chronic pain, has gained increasing interest for the treatment of PDPH because it is a safe and effective technique. In the literature, however, there are few reports of its use in the treatment of PDPH. The two cases described suggest a simple, minimally invasive use and with great potential in the treatment of PDPH.