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Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial

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@article{61e8f2560920433d9cee5b73b6f7f88b,
title = "Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial",
abstract = "BACKGROUND: Current treatment of postdural puncture headache includes epidural blood patch (EBP), which is invasive and may result in rare but severe complications. Sphenopalatine ganglion block is suggested as a simple, minimally invasive treatment for postdural puncture headache. We aimed to investigate the analgesic effect of a transnasal sphenopalatine ganglion block with local anaesthetic vs saline.METHODS: We conducted a blinded, randomised clinical trial including adults fulfilling the criteria for EBP. Participants received a sphenopalatine ganglion block bilaterally with 1 ml of either local anaesthetic (lidocaine 4% and ropivacaine 0.5%) or placebo (saline). Primary outcome was pain in upright position 30 min post-block, measured on a 0-100 mm VAS.RESULTS: We randomised 40 patients with an upright median pain intensity of 74 and 84 mm in the local anaesthetic and placebo groups at baseline, respectively. At 30 min after sphenopalatine ganglion block, the median pain intensity in upright position was 26 mm in the local anaesthetic group vs 37 mm in the placebo group (estimated median difference: 5 mm; 95% confidence interval: -14 to 21; P=0.53). In the local anaesthetic group, 50% required an EBP compared with 45% in the placebo group (P=0.76).CONCLUSIONS: Administration of a sphenopalatine ganglion block with local anaesthetic had no statistically significant effect on pain intensity after 30 min compared with placebo. However, pain was reduced and EBP was avoided in half the patients of both groups, which suggests a major effect not necessarily attributable to local anaesthetics.CLINICAL TRIAL REGISTRATION: NCT03652714.",
keywords = "epidural blood patch, headache, pain management, placebo, postdural puncture headache, sphenopalatine ganglion block, Single-Blind Method, Humans, Middle Aged, Male, Treatment Outcome, Young Adult, Denmark, Adult, Female, Sphenopalatine Ganglion Block/methods, Post-Dural Puncture Headache/therapy",
author = "Jespersen, {Mads S} and Pia Jaeger and {\AE}gidius, {Karen L} and Fabritius, {Maria L} and Patricia Duch and Ida Rye and Arash Afshari and Meyhoff, {Christian S}",
note = "Copyright {\textcopyright} 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.",
year = "2020",
month = jun,
doi = "10.1016/j.bja.2020.02.025",
language = "English",
volume = "124",
pages = "739--747",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",
number = "6",

}

RIS

TY - JOUR

T1 - Sphenopalatine ganglion block for the treatment of postdural puncture headache

T2 - a randomised, blinded, clinical trial

AU - Jespersen, Mads S

AU - Jaeger, Pia

AU - Ægidius, Karen L

AU - Fabritius, Maria L

AU - Duch, Patricia

AU - Rye, Ida

AU - Afshari, Arash

AU - Meyhoff, Christian S

N1 - Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

PY - 2020/6

Y1 - 2020/6

N2 - BACKGROUND: Current treatment of postdural puncture headache includes epidural blood patch (EBP), which is invasive and may result in rare but severe complications. Sphenopalatine ganglion block is suggested as a simple, minimally invasive treatment for postdural puncture headache. We aimed to investigate the analgesic effect of a transnasal sphenopalatine ganglion block with local anaesthetic vs saline.METHODS: We conducted a blinded, randomised clinical trial including adults fulfilling the criteria for EBP. Participants received a sphenopalatine ganglion block bilaterally with 1 ml of either local anaesthetic (lidocaine 4% and ropivacaine 0.5%) or placebo (saline). Primary outcome was pain in upright position 30 min post-block, measured on a 0-100 mm VAS.RESULTS: We randomised 40 patients with an upright median pain intensity of 74 and 84 mm in the local anaesthetic and placebo groups at baseline, respectively. At 30 min after sphenopalatine ganglion block, the median pain intensity in upright position was 26 mm in the local anaesthetic group vs 37 mm in the placebo group (estimated median difference: 5 mm; 95% confidence interval: -14 to 21; P=0.53). In the local anaesthetic group, 50% required an EBP compared with 45% in the placebo group (P=0.76).CONCLUSIONS: Administration of a sphenopalatine ganglion block with local anaesthetic had no statistically significant effect on pain intensity after 30 min compared with placebo. However, pain was reduced and EBP was avoided in half the patients of both groups, which suggests a major effect not necessarily attributable to local anaesthetics.CLINICAL TRIAL REGISTRATION: NCT03652714.

AB - BACKGROUND: Current treatment of postdural puncture headache includes epidural blood patch (EBP), which is invasive and may result in rare but severe complications. Sphenopalatine ganglion block is suggested as a simple, minimally invasive treatment for postdural puncture headache. We aimed to investigate the analgesic effect of a transnasal sphenopalatine ganglion block with local anaesthetic vs saline.METHODS: We conducted a blinded, randomised clinical trial including adults fulfilling the criteria for EBP. Participants received a sphenopalatine ganglion block bilaterally with 1 ml of either local anaesthetic (lidocaine 4% and ropivacaine 0.5%) or placebo (saline). Primary outcome was pain in upright position 30 min post-block, measured on a 0-100 mm VAS.RESULTS: We randomised 40 patients with an upright median pain intensity of 74 and 84 mm in the local anaesthetic and placebo groups at baseline, respectively. At 30 min after sphenopalatine ganglion block, the median pain intensity in upright position was 26 mm in the local anaesthetic group vs 37 mm in the placebo group (estimated median difference: 5 mm; 95% confidence interval: -14 to 21; P=0.53). In the local anaesthetic group, 50% required an EBP compared with 45% in the placebo group (P=0.76).CONCLUSIONS: Administration of a sphenopalatine ganglion block with local anaesthetic had no statistically significant effect on pain intensity after 30 min compared with placebo. However, pain was reduced and EBP was avoided in half the patients of both groups, which suggests a major effect not necessarily attributable to local anaesthetics.CLINICAL TRIAL REGISTRATION: NCT03652714.

KW - epidural blood patch

KW - headache

KW - pain management

KW - placebo

KW - postdural puncture headache

KW - sphenopalatine ganglion block

KW - Single-Blind Method

KW - Humans

KW - Middle Aged

KW - Male

KW - Treatment Outcome

KW - Young Adult

KW - Denmark

KW - Adult

KW - Female

KW - Sphenopalatine Ganglion Block/methods

KW - Post-Dural Puncture Headache/therapy

U2 - 10.1016/j.bja.2020.02.025

DO - 10.1016/j.bja.2020.02.025

M3 - Journal article

C2 - 32303377

VL - 124

SP - 739

EP - 747

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 6

ER -

ID: 60284659