Article Notes
- Roger Browning demonstrating one method for performing a topical SPG block.
- SPG Block for chronic migraine.
- SPG demonstration in the ED setting.
- SPG demonstration for family member to perform later at home.
The association of anesthesia in the sitting beach-chair position with intra-operative stroke, continues to be controversial. Although some studies have identified this as a risk, it is still a rare complication, albeit devastating.
Expert opinion suggests intra-arterial blood pressure monitoring is best practice, but most importantly with consideration for actual cerebral perfusion pressure given the sitting position.
Some research suggests regional anaesthesia, possibly combined with spontaneous ventilation GA (rather than relaxation GA with IPPV) offers unique benefits that better maintain cerebral oxygenation, although the exact difference is unclear.
Similarly, the benefit and role of non-invasive cerebral perfusion monitoring has not been conclusively shown, although it appears logical that it may offer benefit in these patients.
Case studies of patients suffering cerebral ischaemia under beach-chair, do point to combinations of poor intra-operative blood pressure management and possibly pre-existing mild cardiovascular disease (eg. hypertension) as contributing to some degree.
Daniel Jolley
First described in 1909, and then used for treatment of various types of headache and facial pain, the sphenopalatine ganglion block may offer a novel, simple and less-invasive treatment for post-dural puncture headache.
Very little has been published, primarily case studies, case series and retrospective audits. This limited data does however suggest that the technique may be as effective as the traditional epidural blood patch, though with significantly fewer risks.
Larger studies are however needed to properly define the block's role in treating PDPH.
Publications describe a trans-nasal approach, either sitting or supine. First topicalising with co-phenylcaine spray, then placing 2%-4% viscous lignocaine-soaked cotton-tipped applicators for 10 minutes, and finally repeated for a further 20 minutes. Success appears to range from 30-70%.
The mechanism of action may result from parasympathetic blockade at the SPG, resulting in reversal of the cerebral vasodilation thought to be associated with post dural puncture headache.
Several videos showing how simple SPG techniques:
Daniel Jolley
A growing list of significant retracted publications related to anesthesia.
Check out Retraction Watch's Retraction Leaderboard to see how anaesthesiology is (sadly) leading the pack.
Daniel Jolley