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Dwivedi P, Singh P, Patel TK, Bajpai V, Kabi A, Singh Y, Sharma S, Kishore S. Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:782-793. [PMID: 37422191 PMCID: PMC10625157 DOI: 10.1016/j.bjane.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/26/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. METHODS A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. RESULTS After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with "very low" to "moderate" quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. CONCLUSION Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO REGISTRATION CRD42021291707.
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Affiliation(s)
- Priyanka Dwivedi
- All India Institute of Medical Sciences, Department of Anaesthesiology, Gorakhpur, India
| | - Pratibha Singh
- All India Institute of Medical Sciences, Department of Anaesthesiology, Gorakhpur, India
| | - Tejas K Patel
- All India Institute of Medical Sciences, Department of Pharmacology, Gorakhpur, India.
| | - Vijeta Bajpai
- All India Institute of Medical Sciences, Department of Anaesthesiology, Gorakhpur, India
| | - Ankita Kabi
- All India Institute of Medical Sciences, Department of Anaesthesiology, Gorakhpur, India
| | - Yashpal Singh
- Banaras Hindu University, Department of Anaesthesiology, Varanasi, India
| | - Santosh Sharma
- B.R.D. Medical College, Department of Anaesthesiology, Gorakhpur, India
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Taraskiewicz D, Sheeran J, De Marco P, Tiouririne M, Elkassabany N. Etiology, management, and sequela of postdural puncture headache. Curr Opin Anaesthesiol 2023; 36:565-571. [PMID: 37552012 DOI: 10.1097/aco.0000000000001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
PURPOSE The purpose of this article is to provide readers with a concise overview of the cause, incidence, treatment of, and sequalae of postdural puncture headaches (PDPH). Over the past 2 years, much data has been published on modifiable risk factors for PDPH, treatments for PDPH, and sequalae of PDPH particularly long-term. RECENT FINDINGS There is emerging data about how modifiable risk factors for PDPH are not as absolute as once believed. There have been several new meta-analysis and clinical trials published, providing more data about effective therapies for PDPH. Significantly, much recent data has come out about the sequalae, particularly long-term of dural puncture. SUMMARY Emerging evidence demonstrates that in patients who are at low risk of PDPH, needle type and gauge may be of no consequence in a patient developing a PDPH. Although epidural blood patch (EBP) remains the gold-standard of therapy, several other interventions, both medical and procedural, show promise and may obviate the need for EBP in patients with mild-moderate PDPH. Patients who endure dural puncture, especially accidental dural puncture (ADP) are at low but significant risk of developing short term issues as well as chronic pain symptoms.
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Affiliation(s)
- Daniel Taraskiewicz
- Department of Anesthesiology, University of Virginia, School of Medicine, Hospital of the University of Virginia, Virginia, USA
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Abotaleb AM, ElSharkawy MS, Almawardy HG. Bilateral sphenopalatine ganglion block with adrenaline additive for post-dural puncture headache in orthopedic patients: A randomized controlled trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2077051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Amany Mohamed Abotaleb
- Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohammed Said ElSharkawy
- Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hussen Gamal Almawardy
- Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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Abstract
PURPOSE OF REVIEW This manuscript aims to review the risks and the current treatments for postdural puncture headache (PDPH). RECENT FINDINGS PDPH is a relatively frequent complication after neuraxial blocks. It is typically orthostatic in nature, presenting as a positional and dull aching or throbbing headache, with added dysregulation of auditory and/or visual signals. Certain characteristics, such as female sex and young age, may predispose patients to the development of PDPH, as may factors such as previous PDPH, bearing down during the second stage of labor, and the neuraxial technique itself. Long-term complications including chronic headache for years following dural puncture have brought into question of the historical classification of PDPH as a self-limiting headache. So far, the underlying mechanism governing PDPH remains under investigation, while a wide variety of prophylactic and therapeutic measures have been explored with various degree of success. In case of mild PDPH, conservative management involving bed rest and pharmacological management should be used as first-line treatment. Nerve blocks are highly efficient alternatives for PDPH patients who do not respond well to conservative treatment. In case of moderate-to-severe PDPH, epidural blood patch remains the therapy of choice. An interdisciplinary approach to care for patients with PDPH is recommended to achieve optimal outcomes.
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Alwarhi F, Albaqami M, Alqarni A. The efficacy of sphenopalatine ganglion block for the treatment of postdural puncture headache among obstetric population. Saudi J Anaesth 2022; 16:45-51. [PMID: 35261588 PMCID: PMC8846236 DOI: 10.4103/sja.sja_651_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/13/2021] [Accepted: 09/26/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Methods: Results: Conclusions:
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Takmaz SA, Karaoğlan M, Baltacı B, Bektaş M, Başar H. Transnasal Sphenopalatine Ganglion Block for Management of Postdural Puncture Headache in Non-Obstetric Patients. J NIPPON MED SCH 2021; 88:291-295. [PMID: 34471063 DOI: 10.1272/jnms.jnms.2021_88-406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study investigated the efficacy and safety of transnasal sphenopalatine ganglion block (SPGB) for treatment of postural puncture headache (PDPH) in non-obstetric patients. METHODS This retrospective study was conducted at the Ankara Research and Educational Hospital, in Turkey, and included 26 non-obstetric patients (age, ≥18 years) who were diagnosed with PDPH and unresponsive to conservative therapy or unable to continue it because of side effects. Transnasal SPGB was performed in each nostril. Pain severity was assessed with the Visual Analogue Scale (VAS) at 15 min, 30 min, 24 h, and 48 h after the procedure, while patients were seated. The patients were monitored for 48 h for adverse effects (AEs). Patient treatment satisfaction was assessed at 48 h after the procedure by using the Patient Global Impression of Change (PGIC) scale. RESULTS Headache at 15 min post-procedure was relieved rapidly. At 24 h post-procedure, nearly half of patients (42.3%) had no pain, and all patients (100%) had a VAS score of <3. Nasal discomfort, throat numbness, and nausea were AEs reported after SPGB; however, these AEs were completely relieved at 24 h after the procedure. According to the PGIC scale scores at 48 h post-procedure, 73.1% of patients evaluated themselves as "much improved" and 26.9% evaluated themselves as "very much improved". CONCLUSION When PDPH does not respond to conservative treatment, it may be treated effectively with transnasal SPGB, which is a noninvasive, safe, well-tolerated, and straightforward method with a low complication rate.
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Affiliation(s)
- Suna Akın Takmaz
- Department of Algology, Ankara Research and Educational Hospital
| | | | - Bülent Baltacı
- Department of Anesthesiology and Reanimation, Ankara Research and Educational Hospital
| | - Meltem Bektaş
- Department of Anesthesiology and Reanimation, Ankara Research and Educational Hospital
| | - Hülya Başar
- Department of Anesthesiology and Reanimation, Ankara Research and Educational Hospital
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De Leon-Casasola O, Matson BL, Juarez F. Intranasal lidocaine sphenopalatine block: a case of unanswered questions versus unquestioned answers. Reg Anesth Pain Med 2021; 47:74-75. [PMID: 34385293 DOI: 10.1136/rapm-2021-102891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Oscar De Leon-Casasola
- Anesthesiology and Pain, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.,Anesthesiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Benjamin L Matson
- Anesthesiology and Pain, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA .,Anesthesiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Felipe Juarez
- Anesthesiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Santos NS, Nunes JM, Font ML, Carmona C, Castro MM. Early versus late sphenopalatine ganglion block with ropivacaine in postdural puncture headache: an observational study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021; 73:42-45. [PMID: 33762195 PMCID: PMC9801200 DOI: 10.1016/j.bjane.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 12/27/2020] [Accepted: 01/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Postdural puncture headache (PDPH) is a common complication of neuraxial techniques which delays patients.ÇÖ discharge. Sphenopalatine ganglion block (SPGB) is a safe bedside technique with comparable efficacy to Epidural Blood Patch, the gold-standard treatment. There is no evidence on the ideal timing for SPGB performance. We aimed to evaluate the difference between early versus late SPGB concerning efficacy, symptom recurrence and hospital length of stay. METHODS We present an observational study with 41 patients diagnosed with PDPH who were submitted to SPGB with ropivacaine 0,75%. The study sample (n=41) was divided in two groups: an early (less than 24hours after diagnosis) and a late (more than 24hours after diagnosis) SPGB group. Pain was evaluated 15minutes after the block and follow up occurred daily until patients were discharged. PATIENTS ÇÖ demographic characteristics, neuraxial technique, timing of SPGB, qualitative pain relief and post-SPGB length of stay were registered and analyzed with SPSS statistics (v26) software. RESULTS Early SPGB resulted in a significant reduction in length of stay (p=0,009) and symptom recurrence (p=0,036), showing equally effective pain relief, compared to late SPGB. CONCLUSIONS SPGB was equally effective in both groups. Data showed that early SPGB reduces length of hospital stay and symptom recurrence, which potentially allows early resumption of daily activities and a reduction in total health costs.
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López T, Sastre JA, Gómez-Ríos MA. Sphenopalatine block with lidocaine spray for treatment of obstetric postdural puncture headache. J Clin Anesth 2020; 68:110069. [PMID: 33096516 DOI: 10.1016/j.jclinane.2020.110069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/10/2020] [Accepted: 09/20/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Teresa López
- Department of Anesthesiology, Salamanca University Hospital, Salamanca, Spain.
| | - José A Sastre
- Department of Anesthesiology, Salamanca University Hospital, Salamanca, Spain
| | - Manuel A Gómez-Ríos
- Department of Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
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Anthony Cometa M, Zasimovich Y, Smith CR. Percutaneous sphenopalatine ganglion block: an alternative to the transnasal approach. Int J Obstet Anesth 2020; 45:163-164. [PMID: 33199256 PMCID: PMC7567671 DOI: 10.1016/j.ijoa.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/10/2020] [Accepted: 10/06/2020] [Indexed: 12/02/2022]
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Retrospective Study on Ganglionic and Nerve Block Series as Therapeutic Option for Chronic Pain Patients with Refractory Neuropathic Pain. Pain Res Manag 2020; 2020:6042941. [PMID: 32774567 PMCID: PMC7399767 DOI: 10.1155/2020/6042941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/03/2020] [Accepted: 06/13/2020] [Indexed: 11/18/2022]
Abstract
Objective Current recommendations controversially discuss local infiltration techniques as specific treatment for refractory pain syndromes. Evidence of effectiveness remains inconclusive and local infiltration series are discussed as a therapeutic option in patients not responding to standard therapy. The aim of this study was to investigate the effectiveness of infiltration series with techniques such as sphenopalatine ganglion (SPG) block and ganglionic local opioid analgesia (GLOA) for the treatment of neuropathic pain in the head and neck area in a selected patient group. Methods In a retrospective clinical study, 4960 cases presenting to our university hospital outpatient pain clinic between 2009 and 2016 were screened. Altogether, 83 patients with neuropathic pain syndromes receiving local infiltration series were included. Numeric rating scale (NRS) scores before, during, and after infiltration series, comorbidity, and psychological assessment were evaluated. Results Maximum NRS before infiltration series was median 9 (IQR 8–10). During infiltration series, maximum NRS was reduced by mean 3.2 points (SD 3.3, p < 0.001) equaling a pain reduction of 41.0% (SD 40.4%). With infiltration series, mean pain reduction of at least 30% or 50% NRS was achieved in 54.2% or 44.6% of cases, respectively. In six percent of patients, increased pain intensity was noted. Initial improvement after the first infiltration was strongly associated with overall improvement throughout the series. Conclusion This study suggests a beneficial effect of local infiltration series as a treatment option for refractory neuropathic pain syndromes in the context of a multimodal approach. This effect is both significant and clinically relevant and therefore highlights the need for further randomized controlled trials.
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Levin D, Cohen S. Images in anesthesiology: three safe, simple, and inexpensive methods to administer the sphenopalatine ganglion block. Reg Anesth Pain Med 2020; 45:880-882. [DOI: 10.1136/rapm-2020-101765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 11/03/2022]
Abstract
The sphenopalatine ganglion (SPG) block is a simple and valuable technique that was discovered over a century ago, but, unfortunately, very few anesthesiology providers are familiar with this block. After some of our recent publications, physicians from different countries have reached out to us requesting more specifics on how we perform our version of the block. In this report, we provide a brief history of the block and demonstrate our three effective, simple, readily available, and inexpensive methodologies with images. We are proud to share that our three SPG block techniques have so far effectively relieved patients of chronic migraines, acute migraines, tension headaches, moderate-to-severe back pain, and post-dural puncture headaches.
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Jespersen MS, Jaeger P, Ægidius KL, Fabritius ML, Duch P, Rye I, Afshari A, Meyhoff CS. Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial. Br J Anaesth 2020; 124:739-747. [DOI: 10.1016/j.bja.2020.02.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 12/14/2022] Open
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Olsen KR, Cometa MA, Zasimovich Y. Pterygopalatine Ganglion Block as a Rescue Technique for Failed Epidural Blood Patch. Turk J Anaesthesiol Reanim 2020; 48:502-504. [PMID: 33313591 PMCID: PMC7720828 DOI: 10.5152/tjar.2020.06887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/27/2019] [Indexed: 12/26/2022] Open
Abstract
Placement of an epidural blood patch is the gold standard treatment for a postdural puncture headache when conservative measures have failed. If unsuccessful in relieving the symptoms, a second epidural blood patch may be warranted. However, when the accepted gold standard treatment has failed, alternative therapies may be pursued. A pterygopalatine ganglion block has been shown to be effective as an alternative to epidural blood patch placement. This case demonstrates the use of a suprazygomatic pterygopalatine ganglion block as a rescue technique for failed repeated epidural blood patch, with complete and permanent resolution of the headache.
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Affiliation(s)
- Kevin R Olsen
- Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - M Anthony Cometa
- Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Yury Zasimovich
- Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
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Hickerson LC, Madden AM, Keeyapaj W, Cheung AT. Sphenopalatine Ganglion Blockade for the Management of Postdural Puncture Headache After Lumbar Drain Placement in Patients Undergoing Thoracoabdominal Aortic Aneurysm Repair. J Cardiothorac Vasc Anesth 2020; 34:2736-2739. [PMID: 32553645 DOI: 10.1053/j.jvca.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Leigh C Hickerson
- Division of Cardiothoracic Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Anne-Marie Madden
- Division of Cardiothoracic Anesthesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Worasak Keeyapaj
- Division of Cardiothoracic Anesthesiology, Stanford Health Care, Palo Alto, CA
| | - Albert T Cheung
- Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Stanford Health Care, Palo Alto, CA
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Xavier J, Pinho S, Silva J, Nunes CS, Cabido H, Fortuna R, Araújo R, Lemos P, Machado H. Postdural puncture headache in the obstetric population: a new approach? Reg Anesth Pain Med 2020; 45:373-376. [DOI: 10.1136/rapm-2019-101053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 11/03/2022]
Abstract
Background and objectivesThe gold standard for the treatment of postdural puncture headache (PDPH) is the epidural blood patch (EBP). Regional techniques—sphenopalatine ganglion block (SPGB), greater occipital nerve block (GONB) and trigger point infiltration (TPI)—can also be used for the treatment of PDPH. Our objective was to evaluate the efficacy of these peripheral nerve blocks (PNBs) in the treatment of PDPH.MethodsA retrospective study was conducted including all patients with PDPH in the obstetrics department of our institution between April 2016 and December 2017. Data were retrieved from clinical records regarding anesthetic technique, symptoms, treatment, Numeric Pain Score (NPS) before and after treatment, among others.ResultsWe observed 50 cases of PDPH: 25 following spinal anesthesia, 19 following epidural block and 6 following combined spinal-epidural. Of these, seven were managed conservatively and one received EBP as first-line treatment. The remaining 42 patients received PNB as first-line treatment. Of these, 27 received only 1 course of PNB, while 15 received 2 courses. We observed a statistically significant improvement in the NPS after the first course of blocks (n=42), with a reduction of the median NPS by 6.0 (IQR 4.0–7.5; p<0.001). Improvement was also observed after the second course of blocks (n=15), with a reduction of the median NPS of 3.5 (IQR 1.5–5.0; p=0.02). Due to treatment failure, 9 of the 42 patients treated with PNB required EBP. None of these were cases following spinal anesthesia.ConclusionSPGB, GONB and TPI can be safe and effective options for treatment of PDPH, but do not completely eliminate the need for EBP. Prospective studies designed to identify factors associated with unsuccessful treatment are required.
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Prasad C, Kumar R, Verma V, Swati. Comparative evaluation of conservative management and sphenopalatine ganglion block for postdural puncture headache: A randomized controlled trial. BALI JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.4103/bjoa.bjoa_127_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Stalls C, Zatochill M, Petersen TR, Falcon RJ, Al Haddadin C, Southwell B, Soneru CN. Transnasal Sphenopalatine Ganglion Block for Postdural Puncture Headache in an Adolescent: A Case Report. A A Pract 2019; 13:185-187. [DOI: 10.1213/xaa.0000000000001029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sphenopalatine Ganglion Block May Be an Efficient Treatment of Headache After Lumboperitoneal Shunt Placement: A Case Report. A A Pract 2019; 12:401-402. [DOI: 10.1213/xaa.0000000000000944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Treatment of obstetric post-dural puncture headache. Part 1: conservative and pharmacological management. Int J Obstet Anesth 2019; 38:93-103. [DOI: 10.1016/j.ijoa.2018.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/12/2018] [Accepted: 12/16/2018] [Indexed: 12/18/2022]
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Topical Sphenopalatine Ganglion Block Compared With Epidural Blood Patch for Postdural Puncture Headache Management in Postpartum Patients: A Retrospective Review. Reg Anesth Pain Med 2019; 43:880-884. [PMID: 30063655 DOI: 10.1097/aap.0000000000000840] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Postdural puncture headache (PDPH) is a severe and debilitating complication of unintentional dural puncture. The criterion-standard treatment for PDPH has been epidural blood patch (EBP), but it is an invasive intervention with the potential for severe complications, such as meningitis and paralysis. We believe this is the first ever 17-year retrospective chart review in which we compare the effectiveness of sphenopalatine ganglion block (SPGB) to EBP for PDPH treatment in postpartum patients. METHODS We conducted a chart review of the first authors' obstetric patients who experienced PDPH from an unintentional dural puncture from a 17-gauge Tuohy needle for labor epidural from January 1997 to July 2014. Demographic characteristics, headache severity, and associated symptoms were collected prior to treatment. Forty-two patients who received SPGB and 39 patients who received EBP were identified. Residual headache, recovery from associated symptoms, and new treatment complications were compared between the 2 groups at 30 minutes, 1 hour, 24 hours, 48 hours, and 1 week posttreatment. RESULTS A greater number of patients showed significant relief in their PDPH and associated symptoms at 30 and 60 minutes after treatment with SPGB than after treatment with EBP (P < 0.01). Only the EBP patients complained of posttreatment complications, which all resolved in 48 hours. CONCLUSIONS A greater number of patients experienced a quicker onset of headache relief, without any new complications, from treatment with SPGB versus EBP. We believe that SPGB is a safe, inexpensive, and well-tolerated treatment. We hope that clinical trials will be conducted in the future that will confirm our findings and allow us to recommend SPGB for PDPH treatment prior to offering patients EBP.
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Abdelaal Ahmed Mahmoud A, Mansour AZ, Yassin HM, Hussein HA, Kamal AM, Elayashy M, Elemady MF, Elkady HW, Mahmoud HE, Cusack B, Hosny H, Abdelhaq M. Addition of Neostigmine and Atropine to Conventional Management of Postdural Puncture Headache. Anesth Analg 2018; 127:1434-1439. [DOI: 10.1213/ane.0000000000003734] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Furtado I, Lima IFD, Pedro S. Ropivacaine use in transnasal sphenopalatine ganglion block for post dural puncture headache in obstetric patients – case series. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 29402441 PMCID: PMC9391829 DOI: 10.1016/j.bjane.2017.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose Sphenopalatine ganglion block is widely accepted in chronic pain; however it has been underestimated in post dural puncture headache treatment. The ganglion block does not restore normal cerebrospinal fluid dynamics but effectively reduces symptoms associated with resultant hypotension. When correctly applied it may avoid performance of epidural blood patch. The transnasal approach is a simple and minimally invasive technique. In the cases presented, we attempted to perform and report the ganglion block effectiveness and duration, using ropivacaine. Clinical features We present four obstetrics patients with post dural puncture headache, after epidural or combined techniques, with Tuohy needle 18G that underwent a safe and successful sphenopalatine ganglion block. We performed the block 24–48 h after dural puncture, with 4 mL of ropivacaine 0.75% in each nostril. In three cases pain recurred within 12–48 h, although less intense. In one patient a second block was performed with complete relief and without further recurrence. In the other two patients a blood patch was performed without success. All patients were asymptomatic within 7 days. Conclusion The average duration of analgesic effect of the block remains poorly defined. In the cases reported, blocking with ropivacaine was a simple, safe and effective technique, with immediate and sustained pain relief for at least 12–24 h.
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Affiliation(s)
- Inês Furtado
- Hospital Garcia de Orta, Departamento de Anestesiologia, Almada, Portugal.
| | | | - Sérgio Pedro
- Hospital Garcia de Orta, Departamento de Anestesiologia, Almada, Portugal
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Uso de ropivacaína em bloqueio do gânglio esfenopalatino via transnasal para cefaleia pós‐punção dural em pacientes obstétricas – série de casos. Braz J Anesthesiol 2018; 68:421-424. [DOI: 10.1016/j.bjan.2017.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 11/22/2017] [Indexed: 11/19/2022] Open
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Crespi J, Bratbak D, Dodick D, Matharu M, Jamtøy KA, Aschehoug I, Tronvik E. Measurement and implications of the distance between the sphenopalatine ganglion and nasal mucosa: a neuroimaging study. J Headache Pain 2018; 19:14. [PMID: 29442191 PMCID: PMC5811417 DOI: 10.1186/s10194-018-0843-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Historical reports describe the sphenopalatine ganglion (SPG) as positioned directly under the nasal mucosa. This is the basis for the topical intranasal administration of local anaesthetic (LA) towards the sphenopalatine foramen (SPF) which is hypothesized to diffuse a distance as short as 1 mm. Nonetheless, the SPG is located in the sphenopalatine fossa, encapsulated in connective tissue, surrounded by fat tissue and separated from the nasal cavity by a bony wall. The sphenopalatine fossa communicates with the nasal cavity through the SPF, which contains neurovascular structures packed with connective tissue and is covered by mucosa in the nasal cavity. Endoscopically the SPF does not appear open. It has hitherto not been demonstrated that LA reaches the SPG using this approach. METHODS Our group has previously identified the SPG on 3 T-MRI images merged with CT. This enabled us to measure the distance from the SPG to the nasal mucosa covering the SPF in 20 Caucasian subjects on both sides (n = 40 ganglia). This distance was measured by two physicians. Interobserver variability was evaluated using the intraclass correlation coefficient (ICC). RESULTS The mean distance from the SPG to the closest point of the nasal cavity directly over the mucosa covering the SPF was 6.77 mm (SD 1.75; range, 4.00-11.60). The interobserver variability was excellent (ICC 0.978; 95% CI: 0.939-0.990, p < 0.001). CONCLUSIONS The distance between the SPG and nasal mucosa over the SPF is longer than previously assumed. These results challenge the assumption that the intranasal topical application of LA close to the SPF can passively diffuse to the SPG.
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Affiliation(s)
- Joan Crespi
- Department of Neurology, St Olav's University Hospital, Edvards Grieg's gate 8, 7030, Trondheim, Norway.
- Department of Neuromedicine and Movement Science, NTNU (University of Science and Technology), Trondheim, Norway.
- Norwegian Advisory Unit on Headaches, Trondheim, Norway.
| | - Daniel Bratbak
- Department of Neuromedicine and Movement Science, NTNU (University of Science and Technology), Trondheim, Norway
- Department of Neurosurgery, St Olav's University Hospital, Trondheim, Norway
| | - David Dodick
- Department of Neuromedicine and Movement Science, NTNU (University of Science and Technology), Trondheim, Norway
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
| | - Manjit Matharu
- National Hospital of Neurology and Neurosurgery, London, UK
| | - Kent Are Jamtøy
- Department of Neuromedicine and Movement Science, NTNU (University of Science and Technology), Trondheim, Norway
- Department of maxillofacial surgery, St Olav's University Hospital, Trondheim, Norway
| | - Irina Aschehoug
- Department of Neuromedicine and Movement Science, NTNU (University of Science and Technology), Trondheim, Norway
| | - Erling Tronvik
- Department of Neurology, St Olav's University Hospital, Edvards Grieg's gate 8, 7030, Trondheim, Norway
- Department of Neuromedicine and Movement Science, NTNU (University of Science and Technology), Trondheim, Norway
- Norwegian Advisory Unit on Headaches, Trondheim, Norway
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Ho KWD, Przkora R, Kumar S. Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review. J Headache Pain 2017; 18:118. [PMID: 29285576 PMCID: PMC5745368 DOI: 10.1186/s10194-017-0826-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/24/2017] [Indexed: 12/02/2022] Open
Abstract
Background Sphenopalatine ganglion is the largest collection of neurons in the calvarium outside of the brain. Over the past century, it has been a target for interventional treatment of head and facial pain due to its ease of access. Block, radiofrequency ablation, and neurostimulation have all been applied to treat a myriad of painful syndromes. Despite the routine use of these interventions, the literature supporting their use has not been systematically summarized. This systematic review aims to collect and summarize the level of evidence supporting the use of sphenopalatine ganglion block, radiofrequency ablation and neurostimulation. Methods Medline, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases were reviewed for studies on sphenopalatine ganglion block, radiofrequency ablation and neurostimulation. Studies included in this review were compiled and analyzed for their treated medical conditions, study design, outcomes and procedural details. Studies were graded using Oxford Center for Evidence-Based Medicine for level of evidence. Based on the level of evidence, grades of recommendations are provided for each intervention and its associated medical conditions. Results Eighty-three publications were included in this review, of which 60 were studies on sphenopalatine ganglion block, 15 were on radiofrequency ablation, and 8 were on neurostimulation. Of all the studies, 23 have evidence level above case series. Of the 23 studies, 19 were on sphenopalatine ganglion block, 1 study on radiofrequency ablation, and 3 studies on neurostimulation. The rest of the available literature was case reports and case series. The strongest evidence lies in using sphenopalatine ganglion block, radiofrequency ablation and neurostimulation for cluster headache. Sphenopalatine ganglion block also has evidence in treating trigeminal neuralgia, migraines, reducing the needs of analgesics after endoscopic sinus surgery and reducing pain associated with nasal packing removal after nasal operations. Conclusions Overall, sphenopalatine ganglion is a promising target for treating cluster headache using blocks, radiofrequency ablation and neurostimulation. Sphenopalatine ganglion block also has some evidence supporting its use in a few other conditions. However, most of the controlled studies were small and without replications. Further controlled studies are warranted to replicate and expand on these previous findings. Electronic supplementary material The online version of this article (10.1186/s10194-017-0826-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kwo Wei David Ho
- Department of Neurology, University of Florida, PO Box 100236,1149 Newell Drive, Room L3-100, Gainesville, FL, 32611, USA.
| | - Rene Przkora
- Department of Anesthesiology, University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA
| | - Sanjeev Kumar
- Department of Anesthesiology, University of Florida, 1600 SW Archer Road, PO Box 100254, Gainesville, FL, 32610, USA
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Cardoso JM, Sá M, Graça R, Reis H, Almeida L, Pinheiro C, Machado D. Bloqueio do gânglio esfenopalatino para cefaleia pós‐punção dural em contexto de ambulatório. Braz J Anesthesiol 2017; 67:311-313. [DOI: 10.1016/j.bjan.2017.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/18/2016] [Accepted: 09/12/2016] [Indexed: 11/25/2022] Open
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Riveros-Pérez E. Is it necessary to continue treating what was caused by one puncture with another one? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Riveros-Pérez E. ¿Es necesario seguir curando con una punción lo que se ocasionó con otra? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Is it necessary to continue treating what was caused by one puncture with another one?☆: ¿Es necesario seguir curando con una punción lo que se ocasionó con otra? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201704000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Katz D, Beilin Y. Review of the Alternatives to Epidural Blood Patch for Treatment of Postdural Puncture Headache in the Parturient. Anesth Analg 2017; 124:1219-1228. [DOI: 10.1213/ane.0000000000001840] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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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; 30:93-97. [PMID: 28416992 PMCID: PMC5392662 DOI: 10.3344/kjp.2017.30.2.93] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/11/2017] [Accepted: 02/13/2017] [Indexed: 11/08/2022] Open
Abstract
The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block has been used for a long time for treating headaches of varying etiologies. For anesthesiologists, treating postdural puncture headaches (PDPH) has always been challenging. The epidural block patch (EBP) was the only option until researchers explored the role of the SPG block as a relatively simple and effective way to treat PDPH. Also, since the existing evidence proving the efficacy of the SPG block in PDPH is scarce, the block cannot be offered to all patients. EBP can be still considered if an SPG block is not able to alleviate pain due to PDPH.
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Affiliation(s)
- Abhijit S Nair
- Department of Anaesthesia and Pain Medicine, Basavatarakam Indo-American Cancer Hospital and Research Centre, Hyderabad, India
| | - Basanth Kumar Rayani
- Department of Anaesthesia and Pain Medicine, Basavatarakam Indo-American Cancer Hospital and Research Centre, Hyderabad, India
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Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in obstetric patients. J Clin Anesth 2016; 34:194-6. [DOI: 10.1016/j.jclinane.2016.04.009] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/07/2016] [Indexed: 11/19/2022]
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Robbins MS, Robertson CE, Kaplan E, Ailani J, Charleston L, Kuruvilla D, Blumenfeld A, Berliner R, Rosen NL, Duarte R, Vidwan J, Halker RB, Gill N, Ashkenazi A. The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache. Headache 2015; 56:240-58. [DOI: 10.1111/head.12729] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew S. Robbins
- Montefiore Headache Center; Bronx NY USA
- Department of Neurology; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx NY USA
| | | | - Eugene Kaplan
- The Kaplan Headache Center, Optimum Health Medical Group, PLLC; Clifton Park NY USA
| | - Jessica Ailani
- Department of Neurology; Medstar Georgetown University Medical Center; Washington DC USA
| | - Larry Charleston
- Department of Neurology; University of Michigan Health System; Ann Arbor MI USA
| | - Deena Kuruvilla
- Department of Neurology; Yale School of Medicine; New Haven CT USA
| | | | - Randall Berliner
- Department of Neurology; Montefiore Medical Center, Albert Einstein College of Medicine; Bronx NY USA
| | - Noah L. Rosen
- Pain and Headache Center, Cushing Neuroscience Institute, Department of Neurology, Hofstra North Shore LIJ Medical Center; Manhasset NY USA
| | - Robert Duarte
- Pain and Headache Center, Cushing Neuroscience Institute, Department of Neurology, Hofstra North Shore LIJ Medical Center; Manhasset NY USA
| | | | | | | | - Avi Ashkenazi
- Department of Medicine (Neurology); Doylestown Hospital; Doylestown PA USA
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Kent S, Mehaffey G. Transnasal sphenopalatine ganglion block for the treatment of postdural puncture headache in the ED. Am J Emerg Med 2015; 33:1714.e1-2. [DOI: 10.1016/j.ajem.2015.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022] Open
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Grant GJ, Schechter D, Redai I, Lax J. Transnasal topical sphenopalatine ganglion block to treat tension headache in a pregnant patient. Int J Obstet Anesth 2014; 23:292-3. [PMID: 24986563 DOI: 10.1016/j.ijoa.2014.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/20/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Affiliation(s)
- G J Grant
- Department of Anesthesiology New York University, School of Medicine, NY, USA.
| | - D Schechter
- Department of Anesthesiology New York University, School of Medicine, NY, USA
| | - I Redai
- Department of Anesthesiology New York University, School of Medicine, NY, USA
| | - J Lax
- Department of Anesthesiology New York University, School of Medicine, NY, USA
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