Sphenopalatine Ganglion Nerve Block for Postdural Puncture Headache in Obstetrics
Sphenopalatine Ganglion Nerve Block for Postdural Puncture Headache in Obstetrics
During labor and delivery, pregnant women may choose to receive pain relief called epidural
 analgesia, which is the delivery of a numbing agent through the back and into a body space
 around the spinal column. This numbs the area of the stomach and the pelvis. Typically the
 numbing agent is lidocaine, which is a local anesthetic like your dentist uses. Some times
 the numbing agent is combined with another medication that causes drowsiness and relieves
 pain called a narcotic. One of the risks associated with having this kind of pain relief is
 unintentional puncture of a sheath of tissue that surrounds and protects the spinal cord when
 inserting the needle. This sheath is called the dura. This would cause the fluid surrounding
 the spinal cord to leak out and this would cause a headache. This headache is called a
 post-dural puncture headache [PDPH]. The headache can be mild or severe. Rarely, PDPH can be
 serious and cause bleeding or small clots in the brain and damage to nerves that come out of
 the brain.

 The purpose of this study is to test the use of a technique that uses a hollow cotton swab
 [no needles] to numb a nerve cell cluster that sits at the very back of the nasal cavity. The
 anatomical name for this nerve cell cluster is the sphenopalatine ganglion. This has been
 done before at BJH and other hospitals with positive results, but no formal studies have been
 conducted here. Also, the sphenopalatine ganglion [SPG] has been the treatment target for
 other kinds of headaches. To numb the SPG, a hollow tip cotton swab [like a long Q-Tip] is
 inserted through the nose to the back of the nasal cavity and a solution of numbing agent is
 slowly pumped through the hollow Q-tip. This study will include a group that will receive a
 salt solution through the swab instead of a numbing agent. Subjects will be offered BJH
 standard care for their headache if they do not have relief from the study procedures.
 Standard care would be decided by their treating physician and may include oral pain
 medications and/or medications like ibuprofen [Motrin] or they could have a procedure called
 an epidural blood patch. This is performed by injecting a small amount of the patient's own
 blood into the areas of the spinal column where the original epidural anesthesia was injected
 in order to "patch" the leaks in the dura.
Inclusion Criteria:

 -  A parturient who received an epidural or CSE for either labor or cesarean delivery -
 including attempted epidural; irrespective of whether a diagnosis of inadvertent
 spinal was noted at the time.

 -  A patient complaining of symptoms of postural headache consistent with postdural
 puncture headache. This is defined by the ICHD-II (International Classification of
 Headache Disorders-II) as one of the following symptoms to be present: headache, neck
 stiffness, tinnitus, hypoacusis (auditory deficit), photophobia, or nausea - symptoms
 which occur within 15 minutes of moving to an upright position (sitting or standing)
 and resolving within 15 minutes of moving to the supine position.

 Exclusion Criteria:

 -  Single-shot spinal anesthesia (unless an epidural was attempted).

 -  Epidural performed for non-obstetric indications.

 -  Patient with a clinically suspected diagnosis of meningitis, intracranial hemorrhage
 or venous thrombosis - unless these have been excluded by neurological assessment
 and/or imaging as appropriate for normal clinical management.

 -  Symptoms or signs of cranial nerve palsy: e.g., diplopia.

 -  Contraindication to performance of epidural blood patch.

 -  Patient refusal or inability to understand consent.