Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations

Esra Uyar Türkyilmaz; Nuray Camgöz Eryilmaz; Nihan Aydin Güzey; Özlem Moraloğ; lu

doi:10.1016/j.bjane.2015.03.004

Scientific Article

Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations

Bloqueio bilateral do nervo occipital maior para tratamento de cefaleia pós-punção dural após cesarianas

Esra Uyar Türkyilmaz; Nuray Camgöz Eryilmaz; Nihan Aydin Güzey; Özlem Moraloğ; lu

http://dx.doi.org/10.1016/j.bjane.2015.03.004 Braz J Anesthesiol, vol.66, n5, p.445-450, 2016

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Abstract

Abstract Background: Post-dural puncture headache (PDPH) is an important complication of neuroaxial anesthesia and more frequently noted in pregnant women. The pain is described as severe, disturbing and its location is usually fronto-occipital. The conservative treatment of PDPH consists of bed rest, fluid theraphy, analgesics and caffeine. Epidural blood patch is gold standard theraphy but it is an invasive method. The greater occipital nerve (GON) is formed of sensory fibers that originate in the C2 and C3 segments of the spinal cord and it is the main sensory nerve of the occipital region. GON blockage has been used for the treatment of many kinds of headache. The aim of this retrospective study is to present the results of PDPH treated with GON block over 1 year period in our institute. Methods: 16 patients who had been diagnosed to have PDPH, and performed GON block after caesarean operations were included in the study. GON blocks were performed as the first treatment directly after diagnose of the PDPH with levobupivacaine and dexamethasone. Results: The mean VAS score of the patients was 8.75 (±0.93) before the block; 3.87 (±1.78) 10 min after the block; 1.18 (±2.04) 2 h after the block and 2.13 (±1.64) 24 h after the block. No adverse effects were observed. Conclusions: Treatment of PDPH with GON block seems to be a minimal invasive, easy and effective method especially after caesarean operations. A GON block may be considered before the application of a blood patch.

Keywords

Post-dural puncture headache, Caesarean operations, GON block

Resumo

Resumo Justificativa: A cefaleia pós-punção dural (CPPD) é uma complicação importante da anestesia neuroaxial e mais frequentemente observada em grávidas. A dor é descrita como intensa, perturbadora, e sua localização é geralmente fronto-occipital. O tratamento conservador da CPPD consiste em repouso no leito, fluidoterapia, analgésicos e cafeína. O tampão sanguíneo peridural é o padrão ouro de tratamento, mas é um método invasivo. O nervo occipital maior (NOM) é formado por fibras sensoriais com origem nos segmentos C2 e C3 da medula espinhal e é o principal nervo sensorial da região occipital. O bloqueio do NOM tem sido usado para o tratamento de muitos tipos de dor de cabeça. O objetivo deste estudo retrospectivo foi apresentar os resultados de CPPD tratada com bloqueio do NOM no período de um ano em nosso instituto. Métodos: Foram incluídas no estudo 16 pacientes diagnosticadas com CPPD e submetidas a bloqueio de NOM após cesariana. Os bloqueios do NOM foram feitos com levobupivacaína e dexametasona como o primeiro tratamento imediatamente após o diagnóstico de CPPD. Resultados: A média dos escores EVA das pacientes foi de 8,75 (±0,93) antes do bloqueio; 3,87 (±1,78) 10 minutos após o bloqueio; 1,18 (±2,04) duas horas após o bloqueio e 2,13 (±1,64) 24 horas após o bloqueio. Efeitos adversos não foram observados. Conclusões: O tratamento da CPPD com bloqueio do NOM parece ser um método minimamente invasivo, fácil e eficaz, especialmente após cesarianas. O bloqueio do NOM pode ser considerado antes da aplicação de um tampão sanguíneo peridural.

Palavras-chave

Cefaleia pós-punção dural, Cesarianas, Bloqueio do NOM

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Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations

Bloqueio bilateral do nervo occipital maior para tratamento de cefaleia pós-punção dural após cesarianas

Esra Uyar Türkyilmaz; Nuray Camgöz Eryilmaz; Nihan Aydin Güzey; Özlem Moraloğ; lu

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