Clinical Trial: Sphenopalatine Ganglion Block Versus Occiptal Nerve Block in Treatment of Post Dural Puncture Headache

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Sphenopalatine Ganglion Block Versus Occiptal Nerve Block in Treatment of Postduarl Puncture Headache

Brief Summary: Postdural puncture headache (PDPH) is a common complication associated with neuraxial anesthesia and diagnostic lumbar puncture (LP). PDPH is defined as a bilateral headache that develops within 7 days and disappears within 14 days after the dural puncture with a distinct postural quality. PDPH causes significant short-term disability, prevents ambulation and care of the newborn (in obstetrics), and results in a prolonged hospital stay.

Detailed Summary:

The sphenopalatine ganglion (SPG) is an extra-cranial neural structure located in the pterygopalatine fossa that has both sympathetic and parasympathetic components as well as somatic sensory roots. The trans-nasal approach is a low risk, noninvasive technique that is easily performed and could potentially be beneficial in the treatment of PDPH through blocking the parasympathetic flow to the cerebral vasculature through the sphenopalatine ganglion which will allow the cerebral vessels to return to normal diameter and thus relieve the headache.

The greater occipital nerve contains sensory fibers from C2 and C3 segments of medulla spinals. It arises from the dorsal ramus of C2 segment, contains a thin branch from C3 segment, and innerves the medial aspect of posterior scalp up to the anterior aspect of vertex. Greater occipital nerve block (GONB) inhibits the pain sensation of this region.

There is some evidence to suggest the effectiveness of GONB in the management of PDPH. Nowadays, guidelines for the management of PDPH were modified and included GONB as a part of standard management of PDPH.

  • Dexamethasone possess potent antiinflammatory and immunosuppressive actions by inhibiting cytokine-mediated pathways.
  • Many providers believe that the local anesthetic produces the rapid onset of headache relief, like an abortive agent, and that the locally acting steroid produces the preventive like action of up to 6 weeks.

Sponsor: Assiut University

Current Primary Outcome: Numeric rating pain score [ Time Frame: from intervention up to 24 hours ]

pain score


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Numeric rating pain score for headache. [ Time Frame: from intervention up to 24 hours ]
    pain score
  • Analgesic consumption [ Time Frame: from intervention up to 24 hours ]
    The total dose of analgesics.


Original Secondary Outcome: Same as current

Information By: Assiut University

Dates:
Date Received: May 14, 2017
Date Started: January 2017
Date Completion: March 2018
Last Updated: May 15, 2017
Last Verified: May 2017