Verification of Sphenopalatine Ganglion Block Success Using Transcranial Doppler in Management of Patients with Postdural Puncture Headache

Background: Sphenopalatine ganglion block (SPGB) is traditionally advised in the management of head and neck pain. Since SPGB is a minimally invasive, repeatable, and simple technique, SPGB should be tried first in the management of postdural puncture headaches (PDPH). Verification of the block's success in diagnostic, prognostic, and therapeutic nerve blocks, is of paramount importance in pain management. Objectives: This study intends to prove the ability of SPGB in the management of PDPH. Transcranial Doppler (TCD) is utilized as an objective measure to assess the block's success by monitoring variations in the cerebral hemodynamics before and after the block procedure. Noninvasive intracranial pressure (nICP) was applied to support the theory which assumes that the vasodilation of the cerebral blood vessels is the precipitating cause of the PDPH, rather than intracranial hypotension. Study Design: Prospective, triple blinded, controlled, clinical trial. Setting: This clinical trial was conducted at Zagazig University. Methods: In the present study, 123 patients were considered who had spinal and/or epidural anesthesia; 63 patients who developed PDPH joined treatment group A and received the SPGB block. The control group B included 60 patients with no PDPH. The patients in group A were evaluated preprocedure by a numerical pain score and at 30 minutes, 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours postprocedure. Furthermore, patients in both groups were evaluated employing TCD before the transnasal block was given, then it was repeated to group A only within one hour after the block. Results: Results analysis revealed that preprocedural pulsatility index (PI) and mean flow velocity (MFV) values in treatment group A were (mean +/- standard deviation [SD]) 0.63 +/- 0.04 and 57.20 +/- 4.85 cm s(-1), respectively. Values of PI and MFV were significantly increased up to (mean +/- SD) 0.87 +/- 0.08 and 71.15 +/- 7.686 cm s(-1), respectively after the block. The computed nICP values preblock and postblock were also within the normal range. Limitations: Performing SPGB without standardized equipment may limit the results of the current study Conclusions: SPGB should be considered as a first treatment modality for PDPH. Moreover, the results indicate that TCD is a successful objective tool in assessing a transnasal sphenopalatine ganglion block.