Determining the Effectiveness of the Sphenopalatine Ganglion (SPG) Block for the Treatment of the Postdural Puncture Headache

Overview

About this study

The purpose of this study is to analyze the effectiveness of the sphenopalatine ganglion (SPG) block with lidocaine vs. SPG block with placebo in preventing the need for epidural blood patch (EBP) in women who develop post dural puncture headache (PDPH) after accidental puncture during placement of lumbar epidural anesthesia (LEA) for labor.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria:

  • Females, age 18-50;
  • Post dural puncture headache (PDPH) after documented accidental dural puncture during placement of lumbar epidural anesthesia (LEA);
  • No better explanation for headache;
  • Onset of headache within 72 hours of delivery.

Exclusion Criteria:

  • Patient refusal;
  • True allergy to local anesthesia;
  • Hereditary Hemorrhagic Telangiectasia;
  • Inability to understand pain scores and other questionnaires;
  • Inability to speak English;
  • Contraindication to acetaminophen or NSAIDs;
  • Temperature >38.5 C;
  • Prior epidural blood patch (EBP) done for this headache.

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location Status Contact

Rochester, Minn.

Mayo Clinic principal investigator

Emily Sharpe, M.D.

Closed-enrolling by invitation

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"Close"
Not open to everyone who meets the eligibility criteria, but only those invited to participate by the study team.

Contact information:

Emily Sharpe M.D.

(507) 284-9839

Sharpe.Emily@mayo.edu

More information

Publications

  • The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block has been used for a long time for treating headaches of varying etiologies. For anesthesiologists, treating postdural puncture headaches (PDPH) has always been challenging. The epidural block patch (EBP) was the only option until researchers explored the role of the SPG block as a relatively simple and effective way to treat PDPH. Also, since the existing evidence proving the efficacy of the SPG block in PDPH is scarce, the block cannot be offered to all patients. EBP can be still considered if an SPG block is not able to alleviate pain due to PDPH. Read More on PubMed
  • To demonstrate a possible alternative treatment for postdural puncture headache (PDPH). Read More on PubMed
  • We seek to test the efficacy of noninvasive sphenopalatine ganglion block for the treatment of acute anterior headache in the emergency department (ED) using a novel noninvasive delivery device. Read More on PubMed
  • This is an analytic, interventional, cross sectional study to evaluate the risk factors of post-dural (post-lumbar) puncture headache (PDPH) and the validity of the diagnostic criteria for PDPH from the ICHD II. Read More on PubMed
  • Spinal anaesthesia developed in the late 1800s with the work of Wynter, Quincke and Corning. However, it was the German surgeon, Karl August Bier in 1898, who probably gave the first spinal anaesthetic. Bier also gained first-hand experience of the disabling headache related to dural puncture. He correctly surmised that the headache was related to excessive loss of cerebrospinal fluid (CSF). In the last 50 yr, the development of fine-gauge spinal needles and needle tip modification, has enabled a significant reduction in the incidence of post-dural puncture headache. Though it is clear that reducing the size of the dural perforation reduces the loss of CSF, there are many areas regarding the pathogenesis, treatment and prevention of post-dural puncture headache that remain contentious. How does the microscopic pattern of collagen alignment in the spinal dura affect the dimensions of the dural perforation? How do needle design, size and orientation influence leakage of CSF through the dural perforation? Can pharmacological methods reduce the symptoms of post-dural puncture headache? By which mechanism does the epidural blood patch cure headache? Is there a role for the prophylactic epidural blood patch? Do epidural saline, dextran, opioids and tissue glues reduce the rate of CSF loss? This review considers these contentious aspects of post-dural puncture headache. Read More on PubMed
  • Spinal anaesthesia was performed on 247 young adult patients with a 25-G needle. Rectal administration of indomethacin had no significant effect on the incidence of postdural puncture headache, which occurred in 16.8% of patients who received the drug compared to 24.5% who received a placebo. A history of headache pre-operatively did not influence the incidence of postlumbar puncture headache. Read More on PubMed
  • One risk with placement of an epidural blood patch (EDBP) is spinal cord or nerve root compression resulting from the epidural blood volume injected, a complication necessitating immediate surgical decompression. We could not find a previous report of this in the literature. Here, we review and discuss one such case. Read More on PubMed
  • Epidural blood patch (EBP) was performed for the treatment of severe postlumbar puncture cephalalgia in 118 young patients. Following the first EBP, 105 patients had relief of headache. Eleven of the 13 in whom it failed had a second EBP, with adequate relief in 10, giving an overall success of 97.5 percent. Lumbar epidural, caudal, and spinal procedures were successful in 3 patients 105 to 380 days after EBP. Soon after EBP, one patient developed facial paralysis and one complained of episodes of vertigo, dizziness, tinnitus, and ataxia without headaches. Residual complications included backache and/or back stiffness in 22 patients and paresthesia in two. Two-year follow-up revealed 95 percent patient acceptance of the procedure. EBP was found to be a safe, effective method for treating severe postlumbar puncture cephalalgia, provided a proper diagnosis is made and there is no contraindication. Read More on PubMed

Study Results Summary

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Supplemental Study Information

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CLS-20506129

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