Abstract
Single or Double Bilateral Greater Occipital Nerve Blocks to manage Headache after Spinal Obstetric Anesthesia
Highlights
Guidelines for obstetric anesthesia recommend neuraxial anesthesia for Cesarean Section (CS) in most patients for being simple to perform, economical and produces rapid onset of anesthesia and complete muscle relaxation [1]
119 women (19.4%) developed Post-Dural Puncture Headache (PDPH); 87 had mild PDPH and received conservative management that resulted in 4-wk success rate of 56.4%
Patients with moderate and severe and mild PDPH that failed to respond to conservative management undertook distal Greater Occipital Nerve Block (GONB) that showed primary, 1-wk and 4-wk success rates of 82.9%, 64.3% and 61.4%, respectively. 25 patients undertook proximal block for success rate of 78%
Summary
Guidelines for obstetric anesthesia recommend neuraxial anesthesia for Cesarean Section (CS) in most patients for being simple to perform, economical and produces rapid onset of anesthesia and complete muscle relaxation [1]. Spinal Anesthesia (SA) carries many hazards, where the incidence of maternal hypotension, without any prophylactic management, is about 80% [2] and about 60% of pregnant women had CS under SA suffer from Post-Dural Puncture Headache (PDPH) [3]. PDPH is caused by excessive leakage of cerebrospinal fluid through the Dural puncture [5] and is distressing condition that may be debilitating and chronic [3]. Time of onset of PDPH was variable; 90% of headaches occur within 3 days of procedure [6] and two thirds within the first 48 hours, but very rarely, it can occur immediately after or develop up to 14 days of the procedure [7]. Most cases of PDPH can resolve spontaneously without treatment within 7 days [8]. PDPH is defined as any headache occurring in the fronto-occipital area after a lumbar puncture that worsens within 15 minutes of sitting or standing and is relieved within 15 minutes of Prolonged bed rest [9], hydration and caffeine intake [10] and analgesia are commonly used as prophylaxis and treatment for PDPH [11]; no substantial evidence supports routine
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