Greater Occipital Nerve Block or Suboccipital Intramuscular Injections are effective for management of Postdural Puncture Headache: A placebo-controlled study

Background: Postdural puncture headache (PDPH) is not uncommon complication of neuroaxial anesthesia and it affects the mother and the newborn. PDPH may be resistant to conservative management and requires intervention. Objectives: To evaluate the outcomes of bilateral greater occipital nerve block (GONB) and bilateral suboccipital intramuscular injection in a placebo-controlled study for management of PDPH. Patients and methods: 50 patients received bilateral saline injection, 32 patients received suboccipital intramuscular injection and 33 patients received GONB using a mixture of 40 mg lidocaine and 8 mg dexamethasone injection . Pain severity was assessed using the Numeric Rating Scale at baseline and weekly for 4-wks and monthly for 6-m after block, Pain-induced disability was assessed using the Oswestry Pain Disability Questionnaire (OPDQ) score and analgesic requirements were graded at baseline, 1, 3-and 6-m after block. The success rate was defined at the end of 6-m follow-up as the frequency of patients who stopped consumption of analgesia and/or had minimal-to-mild disability with OPDQ score of <20. Results: The success rates were 46.2% depending on number of women had stopped analgesia and 52.3% depending on the OPDQ score and was significantly higher among patients received GONB. Patients' distribution according to satisfaction grade was significantly higher in study groups than control groups with non-significant differences between the study groups. Conclusion: The applied procedures are effective for reducing pain severity, consumption of analgesics and improving disability. GONB provided significantly higher success rate,