• Nitu Puthenveettil, Sunil Rajan, Anish Mohan, Jerry Paul, and Lakshmi Kumar.
• Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
• Indian J Anaesth. 2018 Dec 1; 62 (12): 972-977.

Background And AimsPost-dural puncture headache (PDPH) is a consequence of spinal and epidural anaesthesia in approximately 1% of obstetric patients. The gold standard for its treatment is epidural blood patch. Sphenopalatine ganglion block (SPGB) has been proposed as a non-invasive intervention with minimal adverse effect. The primary objective of this study was to assess the efficacy of SPGB for treatment of PDPH. Secondary objectives were to assess onset of analgesia, duration of block and adverse effects.MethodsTwenty parturients diagnosed to have PDPH, resistant to standard treatment modalities such as intravenous fluids, abdominal binder, bed rest and caffeine, were recruited into this prospective observational study. Patients were allocated to either of the two groups. Group A patients received paracetamol 1 g 8 hourly intravenously for a day. If adequate pain relief was not achieved, diclofenac 75 mg 12 hourly was added. Patients in group B received SPGB with 2% lignocaine. Fisher's exact test, Mann-Whitney test and independent sample t-test were used for statistical analysis.ResultsAbout 88.89% patients in group B had adequate pain relief within 5 min of block (P < 0.001). Pain was significantly lower in Group B for up to 8 h, with no adverse effects.ConclusionSPGB is an effective initial modality for managing severe headache in patients with PDPH.

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