Gayathri Guruvayurappan Annushha, Karthik Kanthan, Saravanan Ravi, Meshach Mesia D, Pushparani Anand
Department of Anaesthesiology, SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu, India.
Department of Anaesthesiology, TATA Memorial Hospital, Mumbai, Maharashtra, India.
Saudi J Anaesth. 2022 Oct-Dec;16(4):401-405. doi: 10.4103/sja.sja_780_21. Epub 2022 Sep 3.
Post dural puncture headache (PDPH) delays discharge from hospital. We studied the efficacy of sphenopalatine ganglion (SPG) block, a novel technique in management of PDPH using 0.25% Ropivacaine.
Forty patients presenting with PDPH after urological procedures under spinal anaesthesia were randomized into two groups: Group C and Group S. Group C received conservative treatment with bed rest, adequate hydration and caffeine 200 mg 6 hourly. Group S patients received SPG block (packing bilateral nostril for 10 minutes with 0.25% Ropivacaine). Inj Paracetamol 1 g IV was given as primary analgesic. Intravenous Diclofenac 75 mg was administered as rescue analgesic. Patients were monitored for 72 hours. Total analgesic requirement, time to attain adequate pain relief, headache pain score, patient satisfactory score were compared between the two groups. We compared the PDPH severity score for headache using 5-point scale method and patient satisfaction score using Likert-type scale.
Demographic data, onset of PDPH, needle size, intervention time were statistically insignificant. Total paracetamol consumption was significantly reduced in SPG group. Headache pain score was significantly low in Group S up to 54 hours. Patient satisfaction score was statistically better in Group S. Mean block onset time was 12 minutes. One patient in Group C required Epidural blood patch.
SPG block is an effective alternative in managing patients with PDPH. The need for epidural blood patch is greatly reduced using SPG block. Procedural safety, immediate and sustained pain relief make it an evolving treatment modality for PDPH.
硬膜穿刺后头痛（PDPH）会延迟患者出院。我们研究了蝶腭神经节（SPG）阻滞的疗效，这是一种使用0.25%罗哌卡因治疗PDPH的新技术。
40例在脊髓麻醉下接受泌尿外科手术后出现PDPH的患者被随机分为两组：C组和S组。C组接受保守治疗，包括卧床休息、充足补液以及每6小时口服200 mg咖啡因。S组患者接受SPG阻滞（用0.25%罗哌卡因双侧鼻腔填塞10分钟）。静脉注射1 g对乙酰氨基酚作为主要镇痛药。静脉注射75 mg双氯芬酸作为解救镇痛药。对患者进行72小时监测。比较两组的总镇痛需求量、达到充分疼痛缓解的时间、头痛疼痛评分、患者满意度评分。我们使用5分制方法比较头痛的PDPH严重程度评分，并使用李克特量表比较患者满意度评分。
人口统计学数据、PDPH发作时间、穿刺针规格、干预时间在统计学上无显著差异。SPG组对乙酰氨基酚的总消耗量显著降低。S组在长达54小时内头痛疼痛评分显著较低。S组患者满意度评分在统计学上更高。平均阻滞起效时间为12分钟。C组有1例患者需要进行硬膜外血贴治疗。
SPG阻滞是治疗PDPH患者的一种有效替代方法。使用SPG阻滞可大大减少硬膜外血贴的需求。操作安全性、即时和持续的疼痛缓解使其成为一种不断发展的PDPH治疗方式。
