蝶腭神经节与枕大神经阻滞治疗剖宫产术后硬脊膜穿剌后头痛的随机临床试验。

Sphenopalatine Ganglion versus Greater Occipital Nerve Blocks in Treating Post-Dural Puncture Headache after Spinal Anesthesia for Cesarean Section: A Randomized Clinical Trial.

机构信息

Department of Anesthesia and Intensive Care, Assiut University, Assiut , Egypt.

Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt.

出版信息

Pain Physician. 2021 Jul;24(4):E443-E451.

PMID:34213869

Abstract

BACKGROUND

Despite being invasive, with serious complications, epidural blood patch (EBP) is still considered the gold standard therapy for Post Dural Puncture Headache (PDPH). The use of Peripheral nerve blocks for PDPH are studied here.

OBJECTIVES

To investigate the efficacy of sphenopalatine ganglion block (SPGB) and greater occipital nerve block (GONB) to relieve PDPH and its associated symptoms.

STUDY DESIGN

Randomized comparative single-blind trial.

SETTING

A University hospital.

METHODS

Patients who received spinal anesthesia for elective cesarean section, and then developed PDPH during hospitalization or within 5 days after dural puncture were enrolled to receive GONB (n = 47) or SPGB (n = 46) for treatment of PDPH. GONB Group: Patients received bilateral GONB using 3 mL mixture of 2 mL lidocaine 2% plus 1 mL dexamethasone 4 mg on each side of occipital region. SPGB Group: Patients received bilateral SPGB using the same mixture in each nostril. Assessments included Numeric Rating Scale (NRS) for severity of headache at supine and sitting positions, nausea NRS, neck stiffness, need for EBP, and complications.

RESULTS

The supine and sitting headache NRS scores significantly decreased at 30 minutes after blocks and throughout follow-up period in both groups (P < 0.000). Clinically significant drop of NRS to < 4 was reached earlier in GONB group. There was a significant difference between groups after 2 hours in supine and sitting headache NRS scores (P = 0.020 and 0.030, respectively); however, both treatments showed similar effectiveness from the third hour afterwards (P > 0.05). Both techniques were effective in relieving neck stiffness and nausea (P < 0.000), with no adverse effects.

LIMITATIONS

A limitation to this study was the small sample size.

CONCLUSIONS

GONB and SPGB are equally effective in relieving symptoms of PDPH. Both techniques are safe, simple, and less invasive than EBP.

摘要

背景

尽管硬膜外血贴（EBP）具有侵袭性，且可能会引起严重并发症，但它仍是治疗硬脊膜穿破后头痛（PDPH）的金标准治疗方法。本研究探讨了周围神经阻滞治疗 PDPH 的效果。

目的

研究蝶腭神经节阻滞（SPGB）和枕大神经阻滞（GONB）缓解 PDPH 及其相关症状的效果。

研究设计

随机对照单盲试验。

设置

一所大学医院。

方法

选择接受椎管内麻醉行择期剖宫产的患者，在住院期间或硬脊膜穿刺后 5 天内发生 PDPH 者，纳入研究并接受 GONB（n = 47）或 SPGB（n = 46）治疗。GONB 组：在枕区双侧给予 2 mL 2%利多卡因加 1 mL 4 mg 地塞米松混合液，每侧各 3 mL。SPGB 组：双侧鼻腔各给予相同的混合液。评估包括仰卧位和坐位时头痛的数字评分量表（NRS）、恶心 NRS、颈部僵硬、EBP 需求和并发症。

结果

两组患者在阻滞治疗后 30 分钟和随访期间的仰卧位和坐位头痛 NRS 评分均显著降低（P < 0.000）。GONB 组更早达到 NRS 评分<4 的临床显著下降。在仰卧位和坐位头痛 NRS 评分上，两组在 2 小时后有显著差异（P = 0.020 和 0.030）；然而，从第 3 小时开始，两种治疗方法的效果相似（P > 0.05）。两种技术均能有效缓解颈部僵硬和恶心（P < 0.000），且无不良反应。