Sphenopalatine ganglion blocks for postural puncture headache?

[XRanger]

Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy

Has anyone tried this? Never tried one myself but there are some who have and they said it works. Probably wouldn’t work as well as EBP but if there’s some value, it might worth a try before EBP as it’s pretty simple to do and relatively noninvasive

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[sevoflurane]

For a real PDPH I wouldn’t waste your time with it. I have a couple of partners that use it and these patients indeed get relief but it’s short lasting and come back for definitive treatment. I have recently experienced this. My patient reported 3 hours of pain relief but PDPH returned. So she received an EBP and never heard from her again.

IMO, just do it right the first time.

 

[Globulinus]

I have done a few, tried 0.5% Rop and 0.5% Bupi. No big difference. Easy to do, fast and good pain relieve.
Yes, sometimes, apprx 30%, HA comes back. Requires EBP or redu of block.
I find it useful for quick fix, especially when no extra hands available, on call.
Or 400-450lbs chicks when DP was a direct result of difficult epidural placement to begin with..

 

[Psai]

I have done a few, tried 0.5% Rop and 0.5% Bupi. No big difference. Easy to do, fast and good pain relieve.
Yes, sometimes, apprx 30%, HA comes back. Requires EBP or redu of block.
I find it useful for quick fix, especially when no extra hands available, on call.
Or 400-450lbs chicks when DP was a direct result of difficult epidural placement to begin with..

What kind of 400#er gets a pdph

 

[deleted697535]

For a real PDPH I wouldn’t waste your time with it. I have a couple of partners that use it and these patients indeed get relief but it’s short lasting and come back for definitive treatment. I have recently experienced this. My patient reported 3 hours of pain relief but PDPH returned. So she received an EBP and never heard from her again.

IMO, just do it right the first time.

Some blood patches don't work first time either.
I've done it a few times and about 50:50 didn't hear from them again.

The ones I did hear about again I patched and they sorted that.

For a 2 mins essentially free procedure I'd consider trying it first if the lady lives close enough to the hospital for example

 

[drmwvr]

Some blood patches don't work first time either.
I've done it a few times and about 50:50 didn't hear from them again.

50/50 on the low side for expected success rates. The longer you wait, the greater the success. SGB is a reasonable bridge to EBP to increase success.

 

[PainDrain]

I have done them before for other headache conditions but it’s basically going to be useless for a PDPH. It’s a parasympathetic block and it really has little input into the pathophysiology of a PDPH. I wouldn’t waste your time. These blocks with soaked plegits are useless. The ones I have done in the past involve inserting a needle at the angle of the mandible across the face and into the nasal passage under fluoroscopy. It’s pretty invasive and has a lot of risk, but it works when done properly for some chronic headache and facial pain conditions.

 

[Orin]

The spray thing does work, but it's a bridging maneuver for sure. I prefer the cosyntropin infusions as they seem to last days. I have been thinking about whether I can teach the patient to do it and send them home with plans to repeat PRN.

 

[Globulinus]

What kind of 400#er gets a pdph

Those who don't read textbooks I guess 🙂. I also wondering how they get pregnant...
Happens in real life.

 

[deleted697535]

I have done them before for other headache conditions but it’s basically going to be useless for a PDPH. It’s a parasympathetic block and it really has little input into the pathophysiology of a PDPH. I wouldn’t waste your time. These blocks with soaked plegits are useless. The ones I have done in the past involve inserting a needle at the angle of the mandible across the face and into the nasal passage under fluoroscopy. It’s pretty invasive and has a lot of risk, but it works when done properly for some chronic headache and facial pain conditions.

That really is an amazing post. Did you read the lit on it at all? You probably should

 

[pgg]

They do work. We've done a few. Sometimes the patient's come back for an EBP, sometimes not.

I think a reasonable alternative to an EBP is one of these blocks and a prescription for some Maxalt.