Comparative Evaluation of Sphenopalatine Ganglion Block and Dexmedetomidine Nebulization for Treatment of Post-Dural Puncture Headache in Obstetric Patients: A Randomized Trial
Authors List
Amit Kumar, AIIMS, New Delhi, India
Kamal Kant Chaudhary, AIIMS, New Delhi, India
Shailendra Kumar, AIIMS, New Delhi, India
Sana Y. Hussain, AIIMS, New Delhi, India
Dhruv Jain, AIIMS, New Delhi, India
Heena Garg, AIIMS, New Delhi, India
Introduction
Post-dural puncture headache (PDPH) is one of the common neuraxial anesthesia-related complications. Conventional therapies, such as caffeine, hydration, analgesics, and epidural blood patch, provide variable degrees of relief. This study compares efficacy of transnasal sphenopalatine ganglion block (SPGB) and nebulized dexmedetomidine for PDPH management in parturients.
Aims
To compare the efficacy of trans-nasal sphenopalatine ganglion block (SPGB) and nebulised dexmedetomidine for PDPH management in parturients.
Methods
This is a prospective, double-blind, randomized controlled trial. Seventy parturients with PDPH and a numeric rating scale (NRS) ≥4 were randomized into two groups. Group S received SPGB with 2% lignocaine, and group D received nebulized dexmedetomidine (1 µg/kg). NRS, transcranial Doppler mean flow velocity (MFV), and pulsatility index (PI) were assessed at baseline, 30 minutes, 1,6,12 and 24 hours. Rescue analgesic requirements and patient satisfaction scores were noted.
Results
With similar baseline NRS scores in the two groups, both treatments provided rapid analgesia within 1 hour and maintained it up to 6 hours. Pain was significantly lower with SPGB at 12 hours vs dexmedetomidine nebulisation (p < 0.001). Rescue analgesic use was lower in group S. SPGB had higher PI, suggesting improved cerebrovascular tone.
Conclusion
In parturients, SPGB provided superior pain control, reduced rescue analgesic use, and greater patient satisfaction compared with nebulized dexmedetomidine for PDPH.
References:
Amit Kumar, AIIMS, New Delhi, India
Kamal Kant Chaudhary, AIIMS, New Delhi, India
Shailendra Kumar, AIIMS, New Delhi, India
Sana Y. Hussain, AIIMS, New Delhi, India
Dhruv Jain, AIIMS, New Delhi, India
Heena Garg, AIIMS, New Delhi, India
Introduction
Post-dural puncture headache (PDPH) is one of the common neuraxial anesthesia-related complications. Conventional therapies, such as caffeine, hydration, analgesics, and epidural blood patch, provide variable degrees of relief. This study compares efficacy of transnasal sphenopalatine ganglion block (SPGB) and nebulized dexmedetomidine for PDPH management in parturients.
Aims
To compare the efficacy of trans-nasal sphenopalatine ganglion block (SPGB) and nebulised dexmedetomidine for PDPH management in parturients.
Methods
This is a prospective, double-blind, randomized controlled trial. Seventy parturients with PDPH and a numeric rating scale (NRS) ≥4 were randomized into two groups. Group S received SPGB with 2% lignocaine, and group D received nebulized dexmedetomidine (1 µg/kg). NRS, transcranial Doppler mean flow velocity (MFV), and pulsatility index (PI) were assessed at baseline, 30 minutes, 1,6,12 and 24 hours. Rescue analgesic requirements and patient satisfaction scores were noted.
Results
With similar baseline NRS scores in the two groups, both treatments provided rapid analgesia within 1 hour and maintained it up to 6 hours. Pain was significantly lower with SPGB at 12 hours vs dexmedetomidine nebulisation (p < 0.001). Rescue analgesic use was lower in group S. SPGB had higher PI, suggesting improved cerebrovascular tone.
Conclusion
In parturients, SPGB provided superior pain control, reduced rescue analgesic use, and greater patient satisfaction compared with nebulized dexmedetomidine for PDPH.
References:
- Elshafei, A.S., Mowafy, S.M.S. Sphenopalatine ganglion block with or without greater occipital nerve block for treatment of obstetric post-dural puncture headache after spinal anesthesia: randomized controlled trial. Ain-Shams J Anesthesiol 15, 76 (2023). https://doi.org/10.1186/s42077-023-00371-1
- Mowafy SMS, Ellatif SEA. Effectiveness of nebulized dexmedetomidine for treatment of post-dural puncture headache in parturients undergoing elective cesarean section under spinal anesthesia: a randomized controlled study. J Anesth. 2021 Aug;35(4):515-524. doi: 10.1007/s00540-021-02944-6. Epub 2021 May 16. PMID: 33993346.
