Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.01.007
Brazilian Journal of Anesthesiology
Original Investigation

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

Bloqueio do gânglio esfenopalatino precoce versus tardio com ropivacaína na cefaleia pós-punção dural: um estudo observacional

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

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Abstract

Background
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.

Methods
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.

Results
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.

Conclusions
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.

Keywords

Postdural puncture headache;  Sphenopalatine ganglion block;  Timing;  Ropivacaine

Resumo

Introdução

A cefaléia pós-punção dural (CPPD) é uma complicação comum das técnicas neuraxiais que atrasa a alta dos pacientes. O bloqueio do gânglio esfenopalatino (BGEP) é uma técnica segura à beira do leito com eficácia comparável ao Blood Patch Epidural, o tratamento padrão-ouro. Não há evidências sobre o momento ideal para o desempenho do BGEP. Nosso objetivo foi avaliar a diferença entre BGEP precoce versus tardio em relação à eficácia, recorrência dos sintomas e tempo de internação.

Métodos

Apresentamos um estudo observacional com 41 pacientes diagnosticados com CPPD que foram submetidos a BGEP com ropivacaína 0,75%. A amostra do estudo (n = 41) foi dividida em dois grupos: grupo BGEP precoce (menos de 24 horas após o diagnóstico) e tardio (mais de 24 horas após o diagnóstico). A dor foi avaliada 15 minutos após o bloqueio e o acompanhamento ocorreu diariamente até a alta do paciente. As características demográficas dos pacientes, a técnica neuraxial, o momento do BGEP, o alívio qualitativo da dor e o tempo de permanência pós-BGEP foram registrados e analisados com o software SPSS statistics (v26).

Resultados

O SPGB precoce resultou em redução significativa no tempo de internação (p = 0,009) e na recorrência dos sintomas (p = 0,036), mostrando alívio da dor igualmente eficaz, em comparação com o SPGB tardio.

Conclusões

BGEP foi igualmente eficaz em ambos os grupos. Os dados mostraram que o BGEP precoce reduz o tempo de internação e a recorrência dos sintomas, o que potencialmente permite a retomada precoce das atividades diárias e uma redução nos custos totais de saúde.

Palavras-chave

Cefaleia pós-punção dural; Bloqueio do gânglio esfenopalatino; Tempo; Ropivacaína

References

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