Early versus late sphenopalatine ganglion block with ropivacaine in postdural puncture headache: an observational study

Abstract Background Postdural puncture headache (PDPH) is a common complication of neuraxial techniques which delays patients' 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 24 hours after diagnosis) and a late (more than 24 hours after diagnosis) SPGB group. Pain was evaluated 15 minutes after the block and follow up occurred daily until patients were discharged. Patients' 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.

Early versus late sphenopalatine ganglion block with ropivacaine in postdural puncture headache: an observational study.

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.

Posture-induced changes in intracranial pressure: a comparative study in patients with and without a cerebrospinal fluid block at the craniovertebral junction.

OBJECTIVE: The aim of this study was to determine posture-induced changes in intracranial pressure (ICP) when patients with hydrocephalus or idiopathic intracranial hypertension remained supine for 1 hour and then sat up and remained sitting for 3 hours. METHODS: Continuous ICP was monitored using a fiberoptic extradural sensor in: 1) 259 patients with hydrocephalus or idiopathic intracranial hypertension with free cerebrospinal fluid (CSF) flow through the craniovertebral junction and Sylvian aqueduct, 2) 20 patients with hydrocephalus secondary to aqueductal stenosis with free CSF flow through the craniovertebral junction, and 3) 97 patients with hydrocephalus associated with Chiari malformation. The maximum ICP difference (DeltaICP) was calculated as the difference between mean ICP in the supine position and minimum ICP value after changing body position. The mean ICP difference (DeltaICPmean) was calculated as the difference between the mean ICP in the supine position and the mean ICP while the patient was in a sitting position. RESULTS: In the complete sample, the median of DeltaICP was 13 mm Hg (interquartile range 10-17). The median of DeltaICPmean was 8 mm Hg (interquartile range 5-11). Both DeltaICP and DeltaICPmean were significantly greater in patients without obstruction in the craniospinal junction than in those with Chiari malformation (P = 0.005 and P = 0.014, respectively). No differences were found in DeltaICP or DeltaICPmean between patients with Sylvian aqueduct stenosis and those without (P = 0.777 and P = 0.346, respectively). CONCLUSION: ICP reduction after a change in body position is significantly greater in patients with free CSF flow through the craniospinal junction than in those with Chiari malformation, indicating the difficulty or impossibility of CSF displacement into the spinal canal in the latter.