原文来自 Regional Anesthesia and Pain Medicine Accepted for publication: August 22, 2014.
Sphenopalatine Ganglion Block A Safer Alternative to Epidural Blood Patch for Postdural Puncture Headache
My colleagues and I read with great interest the case report by Mehta et al,1 which describes a patient with cauda
equina syndrome resulting from an epidural hematoma subsequent to 2 epidural blood patches (EDBPs) for the treatment of postdural puncture headache (PDPH). The authors state that cauda equina syndrome is a rare adverse event that can occur from treatment with an EDBP.1 Epidural blood patches are also known to be associated with other negative sequelae, such as infections, subdural and epidural hematoma, needle trauma, back pain, and a possible second dural puncture.2,3 Thus, we want to suggest the use of a sphenopalatine ganglion block (SPGB), a simple-to-perform, noninvasive intervention with minimal adverse effects that we have used at our institution
to treat PDPHs. At our institution, we apply a cottontipped applicator saturated with 5% watersoluble lidocaine ointment into each nostril for 10 minutes. Our success rates at relieving headaches in this way is astonishing and has influenced us to commence a preliminary study aimed at studying the method’s clinical effectiveness. To date,
32 obstetric patients with PDPHs from accidental dural puncture from a 17-gauge epidural needle were offered an SPGB before an EDBP.5 Approximately 69% of patients were saved from having to undergo the invasive EDBP in favor of a safer, more cost-effective, and less invasive technique. In conclusion, we recommend that every patient with a PDPH receive the minimally invasive SPGB, which in most cases can avoid the need of an EDBP and its potential complications.