蝶腭骨神经阻滞治疗硬膜穿破后头痛

飒琅嘿柒

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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.

我和同事阅读到一个由Mehta等报道的有趣的病例。该报道表述到，患者为治疗硬膜穿破后头痛行2次硬膜外血补丁治疗后继发硬膜外血肿引起马尾综合征。马尾综合征是硬膜外血补丁治疗引起的极少见的不良反应。已知硬膜外血补丁的其余不良反应如感染、硬膜下和硬膜外血肿、穿刺针的损伤、背痛、可能第二次穿刺。所以，我们运用蝶腭骨神经节阻滞（SPGB），一个简单的操作，最小化不良反应的非侵入干预来治疗PDPH。

在我们单位，我们运用棉签沾满5%水溶性的利多卡因软膏置入每侧鼻孔10分钟。运用这种方法减轻头痛的成功率是令人惊讶的。也使我们初步研究这种方法的有效性。迄今为止，有32例因意外的用17G的硬膜外穿刺针穿破硬膜引起PDPH的产科患者，他们在接受硬膜外血补丁前接受SPGB。大约69%的病人免于接受侵入性的EDBP治疗，并且更加安全，更加经济，更少的创伤。

结论：我们推荐有PDPH症状的每一个患者接受更小创伤的SPGB疗法，用这种方法可以使大部分患者避免使用EDBP疗法和其潜在的并发症。

周小毅

好奇，原理是什么

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