Early versus late sphenopalatine ganglion block with ropivacaine in postdural puncture headache: an observational study
Postdural puncture headache (PDPH) is a common complication of neuraxial techniques which delays patients’ discharge. Sphenopalatine ganglion block (SPGB) is a safe bedside technique with comparable efficacy to Epidural Blood Patch, the gold-standard treatment. There is no evidence on the ideal timing for SPGB performance. We aimed to evaluate the difference between early versus late SPGB concerning efficacy, symptom recurrence and hospital length of stay.
We present an observational study with 41 patients diagnosed with PDPH who were submitted to SPGB with ropivacaine 0,75%. The study sample (n = 41) was divided in two groups: an early (less than 24 hours after diagnosis) and a late (more than 24 hours after diagnosis) SPGB group. Pain was evaluated 15 minutes after the block and follow up occurred daily until patients were discharged. Patients’ demographic characteristics, neuraxial technique, timing of SPGB, qualitative pain relief and post-SPGB length of stay were registered and analyzed with SPSS statistics (v26) software.
Early SPGB resulted in a significant reduction in length of stay (p = 0,009) and symptom recurrence (p = 0,036), showing equally effective pain relief, compared to late SPGB.
SPGB was equally effective in both groups. Data showed that early SPGB reduces length of hospital stay and symptom recurrence, which potentially allows early resumption of daily activities and a reduction in total health costs.
 D.K. Turnbull, D.B. Shepherd Post-dural puncture headache: pathogenesis, prevention and treatment Br J Anaesth., 91 (2003), pp. 718-729
 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd Edition. Cephalalgia. 2013;33:629-808.
 A. Sachs, R. Smiley Post-dural puncture headache: the worst common complication in obstetric anesthesia Semin Perinatol., 38 (2014), pp. 386-394
 M.S. Robbins, C.E. Robertson, E. Kaplan, et al. The sphenopalatine Ganglion: Anatomy, Pathophysiology and therapeutic targeting in headache Headache., 56 (2016), pp. 240-258
 P. Nitu, R. Sunil, M. Anish, et al. Sphenopalatine ganglion block for treatment of post-dural puncture headache in obstetric patients: An observational study Indian J Anaesth., 62 (2018), pp. 972-977
 S. Abhijit, A.S. Nair, B.K. Rayani Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy Korean J Pain., 30 (2017), pp. 93-97
 G. Sluder The role of the sphenopalatine ganglion in nasal headaches N.Y. State J. Med., 27 (1908), pp. 8-13
 B. Mohamed, A. Eman, S. Eslam, et al. Sphenopalatine Ganglion Block for the Treatment of Acute Migraine Headache Pain Res Treat. (2018), p. 2516953
 J.M. Neal, J.P. Rathmell Complications in Regional Anesthesia. (2nd ed.), Wolters Kluwer–LWW, Philadelphia (2013)
 S. Cohen, D. Levin, S. Mellender, et al. Topical sphenopalatine ganglion block compared with epidural blood patch for postdural puncture headache management in postpartum patients–a retrospective review Reg Anesth Pain Med., 43 (2018), pp. 880-884
 I. Furtado, I.F. Lima, S. Pedro Ropivacaine use in transnasal sphenopalatine ganglion block for post dural puncture headache in obstetric patients–case series Rev Bras Anestesiol., 68 (2018), pp. 421-424
 S. Kent, G. Mehaffey Transnasal sphenopalatine ganglion block for the treatment of posdural pucture headache in obstetric patients J Clin Anesth., 34 (2016), pp. 194-196
 P. Patel, R. Zhao, S. Cohen Sphenopalatine ganglion block (SPGB) versus epidural blood patch (EBP) for accidental postdural puncture headache (PDPH) in obstetric patients: a retrospective observation Poster presented at: 32nd Annual Meeting of the American Academy of Pain Medicine. (2016), p. 18
 S. Cohen, A. Sakr, S. Katyal, et al. Sphenopalatine ganglion block for postdural puncture headache Anaesthesia., 64 (2009), pp. 574-575
 L.M. Gonçalves, P.M. Godinho, F.J. Durán, et al. Sphenopalatine ganglion block by transnasal approach in post-dural puncture headache J Clin Anesth., 48 (2018), p. 50