P227 Sphenopalatine ganglion block (SPGB) for post-dural puncture headache (PDPH) in a postpartum patient

<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted</b>: Not relevant (see information at the bottom of this page) <h3>Background and Aims</h3> Post-dural puncture headache (PDPH) is a feared complication of neuraxial anaesthesia that limits patients` postoperative mobility and ability to follow daily activities due to significant discomfort, which often leads to a prolonged hospital stay. Treatment for PDPH is sometimes challenging. Use of an epidural blood patch is the gold standard but sphenopalatine ganglion block (SPGB) is a less invasive technique with similar capacity for pain relief. <h3>Methods</h3> A 29-year-old female patient received a lumbar epidural catheter for spontaneous birth and on the same day presented with typical symptoms of PDPH. Under conservative treatment with paracetamol, ibuprofen and caffeine, the pain (NRS score 6/10) was still persistent. Nevertheless, she was dismissed home on her own request the next day. Three days later she presented again with persistent pain (NRS score 8/10). An intranasal SPGB was performed using swabs and 2% lidocaine, which resulted in immediate pain reduction (NRS 3/10). However, six hours later the pain returned (NRS 6/10). Another intranasal SPGB was performed using a mucosal atomization device (MAD) and 2% lidocaine, which again resulted in pain reduction (NRS 3/10). Further SPGB was refused and a blood patch was successfully performed, leading to total pain relief (NRS 0/10). <h3>Results</h3> SPGB reduced the pain intensity but was not completely successful. However, whether this was due to the lidocaine concentration used or the delayed time of application remains unclear. <h3>Conclusions</h3> SPGB is a viable non-invasive bedside technique that provides good pain relief. Immediate performance of SPGB using 2–4% lidocaine seems to be the most promising strategy.