Efficacy of Greater Occipital Nerve Block versus Sphenopalatine Ganglion Block for the Treatment of Postdural Puncture Headache after Spinal Anesthesia: A Randomized Clinical Trial.

BACKGROUND

Postdural puncture headache (PDPH) is a common and often debilitating complication following lumbar puncture, affecting approximately 10%-40% of patients. Minimally invasive procedures, such as sphenopalatine ganglion block (SPGB) and greater occipital nerve block (GONB), have shown promising results in the treatment of PDPH. This study aims to compare the efficacy of SPGB and GONB for PDPH and its associated symptoms.

MATERIALS AND

METHODS

This study included 64 patients who developed PDPH following spinal anesthesia and were randomized into two equal groups. Group A received bilateral SPGB, whereas Group B received bilateral GONB using 2 mL of 0.5% bupivacaine with 4 mg dexamethasone. Headache was assessed using the Numerical Rating Scale (NRS) at baseline, 30 min, 1 h, 2 h, 6 h, 12 h, 24 h, 48 h, and 1 week postintervention. In addition to pain scores, associated symptoms, need for rescue analgesia, patient satisfaction score, overall treatment outcomes, and adverse effects were recorded and compared.

RESULT: The supine NRS scores were significantly lower in the GONB group as compared to the SPGB group at 30 min, 1 h and 2 h ( P = 0.029, 0.002, and 0.021, respectively). NRS score was significantly lower in the GONB group as compared to the SPGB group at 30 min, 1 h, 2 h, and 6 h ( P = 0.006, 0.042, 0.009, and 0.012, respectively) in the sitting position as determined by independent Student's t -test. However, both the treatments showed similar effectiveness after 12 h ( P > 0.05). No major adverse effect was observed in both the groups. None of the patients required epidural blood patch in both the groups.

CONCLUSION

The GONB demonstrated superior efficacy in early headache relief compared to the SPGB in patients with PDPH. However, both the interventions were found to be equally effective in reducing headache intensity and associated symptoms over time, particularly beyond the initial few hours after the procedure.