Volume : X, Issue : II, February - 2020

Comparative study between lidocaine 2%, lidocaine 5% and bupivacaine 0.5% in transnasal sphenopalatine ganglion block for the treatment of postdural

Hany E. Fares, Salah A. Mohamed, Fawzy A. Badawy, Khaled A. M. Abdelfattah

Abstract :

Background: Postdural puncture headache (PDPH) is a complication commonly related to neuraxial anesthesia and dural puncture, with an incidence proportional to the diameter of the needle, ranging from 2% with a 29G to 10% with a 27G and 25% with a 25G. The development of fine gauge spinal needles and needle tip modification, has enabled a significant reduction in the incidence of postdural puncture headache. PDPH presents as a dull throbbing pain with a frontal–occipital distribution. PDPH is thought to be due to a cereospinal fluid leak that exceeds the production rate, causing downward traction of the meninges and parasympathetic mediated reflex vasodilatation of the meningeal vessels. The sphenopalatine ganglion (SPG) is an extracranial neural structure located in the pterygopalatine fossa that has both sympathetic and parasympathetic components as well as somatic sensory roots. Sphenopalatine ganglion block (SPGB) has been used for the treatment of migraine, cluster headache and trigeminal neuralgia and can be performed through transcutaneous, transoral or transnasal approaches. Obstetric patients are considered at increased risk for this condition because of their sex, young age, and the widespread use of neuraxial blocks. SPGB is minimally invasive, carried out at the bedside without using imaging and has apparently rapid onset than EBP with better safety profile. The most common side effects of SPGB are all temporary, including numbness in the throat, low blood pressure and nausea. Objectives: We evaluated the efficacy and safety of lidocaine 2%, lidocaine 5% and bupivacaine 0.5% in transnasal sphenopalatine ganglion block for the treatment of post dural puncture headache on 30 patients. Patients and methods: This prospective, randomized and controlled clinical study was conducted at Sohag University Hospital after its approval by the Ethics and Research Committee of Sohag Faculty of Medicine. Written informed consent was obtained from each patient before participation. Results: Our study showed that there were non significant differences between the three studied groups regarding age, gender, body mass index, type of operation, onset, site of headache, associated symptoms, relieving factors and exaggerated follow up. There was a nonsignificant difference between the three studied groups regarding changes in visual analogue score for severity of headache. There were nonsignificant differences between the three studied groups regarding presence of bleeding and results of treatment of postdural puncture headache. Conclusion: SPGB is an effective initial modality for managing severe headache in patients with PDPH.

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Article: Download PDF    DOI : 10.36106/ijar/5620295  

Cite This Article:

COMPARATIVE STUDY BETWEEN LIDOCAINE 2%, LIDOCAINE 5% AND BUPIVACAINE 0.5% IN TRANSNASAL SPHENOPALATINE GANGLION BLOCK FOR THE TREATMENT OF POSTDURAL, Hany E. Fares, Salah A. Mohamed, Fawzy A. Badawy, Khaled A.M. Abdelfattah INDIAN JOURNAL OF APPLIED RESEARCH : Volume-10 | Issue-2 | February-2020


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