Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20190072
Brazilian Journal of Pain
Case Report

Sphenopalatine ganglion block for post-dural puncture headache after invasive cerebrospinal fluid pressure monitoring. Case report

Felipe Chiodini Machado; Gilson Carone Neto; Hazem Adel Ashmawi

Downloads: 0
Views: 216

Abstract

BACKGROUND AND OBJECTIVES: Post-dural puncture headache is a common complication in neuraxial anesthesia and lumbar puncture diagnostic procedures. The pathogenesis of the headache is thought to be due to a leak of cerebrospinal fluid from the puncture site that exceeds the rate of cerebrospinal fluid production, causing a downward traction of the meninges and vasodilation of the meningeal vessels mediated by the autonomous nervous system. Nowadays, the conservative treatment involves hydration, and the use of caffeine, analgesics, hydrocortisone, gabapentin, and theophylline. However, an autologous epidural blood patch is considered the definitive treatment for post-dural puncture headache and has an efficacy of up to 75%. Since this procedure comes with intrinsic risks, an alternative is the sphenopalatine ganglion block.

CASE REPORT: We describe a case report using a sphenopalatine ganglion block to treat post-dural puncture headache in a patient submitted to cerebrospinal fluid pressure monitoring with a subarachnoidal catheter inserted with a low-gauge needle.

CONCLUSION: This is the first case report of a post-dural puncture headache caused by a subarachnoid monitoring catheter successfully treated with sphenopalatine ganglion block. This technique can be a non-invasive option in the management of post-dural puncture headache, which requires more study to evaluate its efficacy and safety.

Keywords

Headache, Post-dural puncture headache, Sphenopalatine ganglion block

References

Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91(5):718-29.

Basurto Ona X, Osorio D, Bonfill Cosp X. Drug therapy for treating post-dural puncture headache. Cochrane Database Sys Rev. 2015;15(7).

Safa-Tisseront V, Thormann F, Malassiné P, Henry M, Riou B, Coriat P. Effectiveness of epidural blood patch in the management of post-dural puncture headache. Anesthesiology. 2001;95(2):334-9.

Paech M. Epidural blood patch-myths and legends. Can J Anesth. 2005:R1-5.

Day M. Sphenopalatine ganglion analgesia. Curr Rev Pain. 1999;3(5):342-7.

Slullitel A, Santos IS, Machado FC, Sousa AM. Transnasal sphenopalatine nerve block for patients with headaches. J Clin Anesth. 2018;47:80-1.

Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED. Am J Emerg Med. 2015;33(11):1714.e1-2.

Edvinsson L. Innervation and effects of dilatory neuropeptides on cerebral vessels. New aspects. Blood Vessels. 1991;28(1-3):35-45.

Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anesth. 2016;34:194-6.

Lima MH, Campos MJ, Valentim A, Paulo L, Rego S, Semedo E. Intranasal self-administration of local anesthetic (ropivacaine) for sphenopalatine ganglion block, for treatment of second trigeminal branch neuralgia secondary to maxillary sinus curettage: a case report. Rev Esp Anestesiol Reanim. 2019;5.

Kim NE, Park B, Moon YR, Lee SY, Gil HY, Kim S. Changes in facial temperature measured by digital infrared thermal imaging in patients after transnasal sphenopalatine ganglion block: retrospective observational study. Medicine (Baltimore). 2019;98(15).

Peterson JN, Schames J, Schames M, King E. Sphenopalatine ganglion block: a safe and easy method for the management of orofacial pain. Cranio. 1995;13(3):177-81.

Furtado IF, Pinto MM, Amorim P. Sphenopalatine ganglion block may be an efficient treatment of headache after lumboperitoneal shunt placement: a case report. A A Pract. 2019;12(11):401-2.

Davies JM, Murphy A, Smith M, O'Sullivan G. Subdural haematoma after dural puncture headache treated by epidural blood patch. Br J Anaesth. 2001;86(5):720-3.

Stalis C, Zatochill M, Petersen TR, Falcon RJ, Al Haddadin C, Southwell B. Transnasal sphenopalatine ganglion block for postdural puncture headache in an adolescent: a case report. A A Pract. 2019;30.

Jespersen MS, Jaeger PT, Aegidius KL, Meyhoff CS. Sphenopalatine ganglion block for treatment of post-dural puncture headache. Ugeskr Laeger. 2019;181(19).

Mehta SP, Keogh BP, Lam AM. An epidural blood patch causing acute neurologic dysfunction necessitating a decompressive laminectomy. Reg Anesth Pain Med. 2014;39(1):78-80.

Tekkök IH, Carter DA, Brinker R. Spinal subdural haematoma as a complication of immediate epidural blood patch. Can J Anaesth. 1996;43(3):306-9.


Submitted date:
05/02/2019

Accepted date:
09/27/2019

5f2491f00e8825372be56d7d brjp Articles
Links & Downloads

BrJP

Share this page
Page Sections