Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache after caesarean section
Keywords: sphenopalatine ganglion block, postdural puncture headache.
Aslan Bilge (M.D)

The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block is used for a long time in the treatment of headache of various reasons. Post dural puncture headache (PDPH) treatment for anesthesiologists has always been problematic. When an SPG block can not relieve pain due to PDPH, an epidural block patch (EBP) is applied.
The Cotton-tipped applicators, one for each nostril, were inserted parallel to the nose floor and advanced until resistance was felt. This represents contact with the posterior nasopharynx wall. Each cotton-tipped applicator was left in place for approximately 10 min. Symptoms relief was reported 5 min after the cotton-tipped applicators were removed. Twenty female patients with postspinal headache after cesarean section were included in the study. Patients were ASA I or II. We used Visuel Analog Scale (VAS) to assess the severity of the headache.     The cotton-tipped applicators was soaked up with 0.3 ml of 0.5% bupivacaine cotton tips before intranasal placement. Following we sent 0.2 ml of 0.5% bupivacaine to the back of the cotton-tipped applicators.
The cotton-tipped applicators was held for 5 minutes intranasal. Then 0.2 ml of bupivacaine was sent through the bar and the rod was held for 5 more minutes. Blood pressure and oxygen saturation were followed. The response was taken immediately after 5 min. However, after 6 hours postspinal headache peaked in five patients (VAS≥4) and SPG block was reapplied to the patients. Patients were discharged 24 hours after being observed and then prescribed caffeine 520 mg-acetaminophen 4000 mg orally in 24 hours.

. References:
1. Turnbull DK, Shepherd DB. Post-dural puncture headache: Pathogenesis, prevention and treatment. Br J Anaesth 2003;91:718-29.
2. Nair AS, Rayani BK. Sphenopalatine ganglion block for relieving postdural puncture  headache: technique and mechanism of action of block with a narrative review of efficacy. Korean J Pain 2017; 30(2):93-97.
3. 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.

10 / Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache after caesarean section
Keywords: Sphenopalatine ganglion block, Postdural puncture headache.

10 / Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache after caesarean section Keywords: Sphenopalatine ganglion block, Postdural puncture headache.