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EP179 Modification of Sphenopalatine Ganglion Block for Treatment of Postural Puncture Headache: A Case Series
  1. Rastogi Amit
  1. Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India


Background and Aims The search for more straightforward to treat PDPH has led to regional blocks like sphenopalatine ganglion block (SPGB) and greater occipital. nerve block and trigger point infiltration. We have evaluated the efficacy of MSGB in treating PDPH. This is an ongoing study, and we are presenting preliminary data of our study in 13 patients as case series.

Methods Patients with typical symptoms of PDPH are recruited in this study. Pain score was assessed before the procedure using NRS (0 – no pain to 10 – worst pain imaginable) in the static and dynamic state. 2 ml of solution (1ml of 2% lignocaine + 1ml of 0.5% ropivacaine or normal saline) was slowly instilled along the superior edge of the middle concha to the posterior wall of the nasopharynx with the help of a dropper in each nostril alternatively as modified spheno palatine ganglion block (MSPGB). After 5 min, the patients were asked to lift their head gradually and be asked to report their pain as per NRS. Subsequently, NRS will be assessed at 2, 4, 8, 12, 16, 24-, 36-, 48- and 72 hours post block. The MSGB was repeated if the patient reported NRS > 4.

Results 13 patients have been given MSPGB, and the median NRS score Pre MSPGB block was 8 but post-MSPGB, median score was reduced to 3,2,3,4,5,4,2.5,2,2 and 1 at 2,4,8,12,16,24,36, 48 and 72 hours respectively.

Conclusions MSGB is a simple & noninvasive method of treating PDPH along with minimal side effects in postoperative care settings.

Abstract EP179 Figure 1

Median NRS scores against various time interval after administration of MSPGB

  • Modified sphenopalatine ganglion block
  • post-dural puncture headache
  • subarchanoid block

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