Furtado Inês, Lima Isabel Flor de, Pedro Sérgio
Hospital Garcia de Orta, Departamento de Anestesiologia, Almada, Portugal.
Hospital Garcia de Orta, Departamento de Anestesiologia, Almada, Portugal.
Braz J Anesthesiol. 2018 Jul-Aug;68(4):421-424. doi: 10.1016/j.bjan.2017.11.007. Epub 2018 Feb 3.
Sphenopalatine ganglion block is widely accepted in chronic pain; however it has been underestimated in post dural puncture headache treatment. The ganglion block does not restore normal cerebrospinal fluid dynamics but effectively reduces symptoms associated with resultant hypotension. When correctly applied it may avoid performance of epidural blood patch. The transnasal approach is a simple and minimally invasive technique. In the cases presented, we attempted to perform and report the ganglion block effectiveness and duration, using ropivacaine.
We present four obstetrics patients with post dural puncture headache, after epidural or combined techniques, with Tuohy needle 18G that underwent a safe and successful sphenopalatine ganglion block. We performed the block 24–48 h after dural puncture, with 4 mL of ropivacaine 0.75% in each nostril. In three cases pain recurred within 12–48 h, although less intense. In one patient a second block was performed with complete relief and without further recurrence. In the other two patients a blood patch was performed without success. All patients were asymptomatic within 7 days.
The average duration of analgesic effect of the block remains poorly defined. In the cases reported, blocking with ropivacaine was a simple, safe and effective technique, with immediate and sustained pain relief for at least 12–24 h.
蝶腭神经节阻滞在慢性疼痛治疗中被广泛接受；然而，其在硬膜外穿刺后头痛治疗中的作用一直被低估。神经节阻滞虽不能恢复正常脑脊液动力学，但能有效减轻因低血压导致的相关症状。正确应用时可避免进行硬膜外血贴治疗。经鼻途径是一种简单且微创的技术。在本文所呈现的病例中，我们尝试使用罗哌卡因进行蝶腭神经节阻滞，并报告其有效性和持续时间。
我们介绍了4例硬膜外或联合技术穿刺后发生硬膜外穿刺后头痛的产科患者，使用18G Tuohy针进行了安全且成功的蝶腭神经节阻滞。我们在硬膜穿刺后24 - 48小时进行阻滞，每侧鼻孔注入4毫升0.75%的罗哌卡因。3例患者在12 - 48小时内疼痛复发，不过程度较轻。1例患者进行了第二次阻滞，疼痛完全缓解且未再复发。另外2例患者进行硬膜外血贴治疗未成功。所有患者在7天内均无症状。
该阻滞镇痛效果的平均持续时间仍不明确。在报告的病例中，罗哌卡因阻滞是一种简单、安全且有效的技术，能立即并持续缓解疼痛至少12 - 24小时。
