Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Early versus late sphenopalatine ganglion block with ropivacaine in postdural puncture headache: an observational study

Nelson S. Santos, Joana M. Nunes, Maria L. Font, Cristina Carmona, Maria M. Castro

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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.


Postdural puncture headache;  Sphenopalatine ganglion block;  Timing;  Ropivacaine


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