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ESRA19-0386 Transnasal sphenopalatine ganglion block for treatment of postdural puncture headache in obstetric patients
  1. M Viegas Ribeiro,
  2. J Pacheco and
  3. F Lança
  1. Centro Hospitalar Lisboa Nrote, Anesthesiology, Lisboa, Portugal


Background and aims Sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. It has been used for treating headaches of multiple etiologies. These two cases comprise SPG block used to treat postdural puncture headache (PDPH) in postpartum patients.

Methods We performed a transnasal SPG block using a cotton-tipped applicator and 2% lidocaine. Pain assessment was performed using the numeric rating scale and it was made before performing the technique and at 0h, 2h, 6h, 12h, 24h and 48h after the block.

Results Two women, ages 30 and 27 years, developed PDPH after spinal analgesia using a 27G and a 25G Quincke needle, respectively. Before the treatment they described 9/10 and 10/10 pain, and after both of them reported significant pain relief within the first 5 minutes. A high degree of pain relief was sustained throughout the first 24 hours post-treatment; however, after this period there was a recurrence of pain, although less intense (8/10). In both patients an epidural blood patch (EBP) was performed after recurrence of pain, which provided symptomatic relief, allowing discharge after 24 hours.

Conclusions Transnasal SPG block is a safe and easy technique with fewer complications than EBP. Given the cases described, it allows a good analgesic control, however, its effect is limited in time, being necessary its reapplication. Since PDPH is self-limited with spontaneous resolution in most cases, the blockade could be done serially until the resolution of the condition, avoiding more invasive techniques with higher risk of severe complications such as the EBP.

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