Abstract
Background and Objective:Post-dural puncture headache (PDPH) is one of the complications frequently observed after spinal or epidural anesthesia with dural penetration. For PDPH patients who do not respond to conservative medical treatment, alternative treatments such as bilateral occipital nerve block should be considered.In this study the efficacy of bilateral occipital nerve block was retrospectively evaluated in patients with post-dural puncture headache.Methods:Ultrasound-guided bilateral occipital nerve block was administrated in 21 patients who developed PDPH after spinal anesthesia, but did not respond to conservative medical treatment within 48 hours between January 2012 and February 2014. The study was conducted at Erzincan University Faculty of Medicine Gazi Mengucek Education and Research Hospital Results:Mean Visual Analog Scale (VAS) pain scores at 10 minutes and 6, 10, 15 and 24 hours after the block were significantly improved compared to the patients with a pre-block VAS score between 4 and 6 as well as patients with a pre-block VAS score between 7 and 9 (p<0.01). After 24 hours of the block applied, VAS pain score dropped to 1 for all 12 patients who had a pre-block VAS score between 4 and 6. Whereas, VAS score decreased to 2 at 24 hours after the block in only one of the patients with a pre-block VAS between 7 and 9. For the patients with a pre-block VAS score between 7 and 9, there was no significant improvement in the mean VAS score 24 hours after the block.Conclusions:For patients with PDPH and a pre-block VAS score between 4 and 6 who do not respond to conservative medical treatment, an ultrasound-guided bilateral occipital nerve block may be effective.
Highlights
Post-dural puncture (PDPH) headache is a common complication for patients with neuroaxial anesthesia.[1]
For patients with Post-dural puncture headache (PDPH) and a pre-block Visual Analog Scale (VAS) score between 4 and 6 who do not respond to conservative medical treatment, an ultrasound-guided bilateral occipital nerve block may be effective
In this study we evaluated the PDPH cases that underwent bilateral greater occipital nerve block, who were referred to Erzincan University Faculty of Medicine Gazi Mengucek Education and Research Hospital, and their response to the therapy
Summary
Post-dural puncture (PDPH) headache is a common complication for patients with neuroaxial anesthesia.[1]. The headache begins at the occipital lobe and spreads to the frontal regions, eventually reaching the neck and shoulders, and intensifies with standing.[4,5] The greater occipital nerve penetrates the semispinal iscapitis & trapezius muscles to innervate the skin along the posterior portion of the scalp to the vertex of the skull and the scalp over the ear and parotid glands.[6,7] It takes sensorial tendons from the C2 and C3 segments of the spinalis. Methods: Ultrasound-guided bilateral occipital nerve block was administrated in 21 patients who developed PDPH after spinal anesthesia, but did not respond to conservative medical treatment within 48 hours between January 2012 and February 2014. Conclusions: For patients with PDPH and a pre-block VAS score between 4 and 6 who do not respond to conservative medical treatment, an ultrasound-guided bilateral occipital nerve block may be effective
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