Uyar Türkyilmaz Esra, Eryilmaz Nuray Camgöz, Güzey Nihan Aydin, Moraloğlu Özlem
Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ancara, Turquia.
Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ancara, Turquia.
Rev Bras Anestesiol. 2016 Sep-Oct;66(5):445-50. doi: 10.1016/j.bjan.2015.12.001. Epub 2016 Jul 18.
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.
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.
The mean VAS score of the patients was 8.75 (±0.93) before the block; 3.87 (±1.78) 10min after the block; 1.18 (±2.04) 2h after the block and 2.13 (±1.64) 24h after the block. No adverse effects were observed.
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.
硬膜穿刺后头痛（PDPH）是神经轴索麻醉的一种重要并发症，在孕妇中更为常见。疼痛被描述为严重、令人困扰，其位置通常在额枕部。PDPH的保守治疗包括卧床休息、液体治疗、镇痛药和咖啡因。硬膜外血贴是金标准治疗方法，但它是一种侵入性方法。枕大神经（GON）由起源于脊髓C2和C3节段的感觉纤维组成，是枕部的主要感觉神经。GON阻滞已被用于治疗多种头痛。这项回顾性研究的目的是展示在我们研究所1年期间用GON阻滞治疗PDPH的结果。
16例被诊断为PDPH且在剖宫产术后接受GON阻滞的患者纳入研究。在诊断PDPH后，立即用左旋布比卡因和地塞米松进行GON阻滞作为首次治疗。
阻滞前患者的平均视觉模拟评分（VAS）为8.75（±0.93）；阻滞后10分钟为3.87（±1.78）；阻滞后2小时为1.18（±2.04）；阻滞后24小时为2.13（±1.64）。未观察到不良反应。
用GON阻滞治疗PDPH似乎是一种微创、简便且有效的方法，尤其是在剖宫产术后。在应用血贴之前可考虑进行GON阻滞。
