Efficacy and Safety of Trans-nasal Sphenoid Ganglion Block in Obstetric Patients With Post-dural Puncture Headache: A Randomized Study.

Introduction This study evaluated the efficacy and safety of two methods to achieve a trans-nasal sphenoid ganglion (SPG) block in obstetric patients for treating a post-dural puncture headache was evaluated. Methods In this prospective single-blinded randomized study, 20 enrolled patients were divided into two groups: group 1 (n=10) received SPG block via the applicator method and group 2 (n=10) by the nasal spray technique. The reduction in the pain score, number of patients requiring rescue analgesia with time to first analgesic request, repeat procedure required, and any adverse event were recorded.  Results Patients in both groups were comparable with respect to the baseline characteristics. After the SPG block, the patients in group 1 had a significant reduction in the visual analog score (VAS) as compared to group 2 in the first 24 hours (P<0.001). Thereafter, the pain scores were comparable between the groups till discharge. Only one patient in group 1 required rescue analgesia as against six in group 2 (P= 0.02, OR= 13.5). The procedure was repeated in 10% of patients in group 1 and 30% of patients in group 2 (P= 0.26, OR= 3.85). On intragroup comparison, both groups revealed a significant reduction in pain from the baseline after the block (P<0.001). Conclusion The trans-nasal SPG block is a minimally invasive treatment option for post-dural puncture headache (PDPH) and avoids the need for more invasive treatment techniques. Among the two approaches of a trans-nasal SPG block, the applicator technique results in better pain relief.