Trans-Nasal Sphenopalatine Ganglion Block for Post-Dural Puncture Headache after Caesarean Delivery: A Prospective, Double-Blind Clinical Trial

Background: An epidural blood patch (EBP) is currently the standard treatment for post-dural puncture headache (PDPH) following caesarean delivery (CD).However, EBP is an invasive procedure associated with potential, though rare, serious complications.As a less invasive alternative, the trans-nasal sphenopalatine ganglion (SPG) block has been proposed.We aimed to investigate the clinical outcomes of a trans-nasal SPG block with local anaesthetics versus normal saline in PDPH patients.Methods: This randomized, double-blind study included 44 patients diagnosed with PDPH, randomly assigned into two equal groups; one patient was lost to follow-up, so 43 patients completed the study.Group A (n = 22) received a trans-nasal SPG block using 1.4 ml of local anaesthetic, comprising 0.7 ml of 4% lignocaine and 0.7 ml of 0.5% ropivacaine administered for 10 minutes.Group B (n = 21) received a placebo consisting of 1.4 ml of 0.9% saline administered for 10 minutes.The primary outcome was pain intensity measured by the numeric rating scale (NRS).Secondary assessments included haemodynamic variables, onset and duration of analgesia (paracetamol), total dose of rescue analgesic, adverse effects, need for an EBP, and patients' satisfaction.Normally distributed data are presented as mean and standard error (SE) and compared using independent t-tests.Non-normally distributed data are shown as median (IQR) and analysed with the Mann-Whitney U test.Categorical variables are reported as counts and percentages, with comparisons made using the chi-square or Fisher's exact test, as appropriate.A P-value < 0.050 were considered statistically significant. Results:All 43 patients had a median upright pain perception score of 5.0 on the NRS in both groups at baseline.At 11 minutes after the trans-nasal SPG block, the median pain score in the upright position was 2.0 (1.4-2.7) in Group A, compared to 5.0 (4.1-5.0) in Group B. The NRS in Group A remained consistently lower throughout the study, with a highly significant difference observed during the first 2 hours after the block, indicating a more rapid onset and longer duration of analgesia.The total dose of rescue paracetamol was significantly lower in Group A. Additionally, the duration of hospital stay for EBP was notably shorter in Group A, which correlated with higher levels of patient satisfaction.Conclusions: PDPH can be treated effectively and rapidly with a trans-nasal SPG block using local anaesthetics, as demonstrated by a reduction in NRS 2 and a significantly lower requirement for rescue analgesia.This approach is minimally invasive, safe, reduces hospital stay for EBP, and is associated with higher levels of patient satisfaction.