Title : Post-dural puncture headache treated with greater occipital nerve block
Abstract:
Post-dural puncture headache (PDPH) is an important and relatively frequent complication after spinal anesthesia. It is intense pain that worsens when sitting or standing and improves when lying down. Epidural blood tamponade is the most effective treatment, but it is invasive. -OBJECTIVE: to demonstrate the results of greater occipital nerve (GON) block in the treatment of PDPH. -METHOD: 3 patients undergoing cesarean section with PDPH were evaluated, who agreed to GON blockade after failure of hydration, rest and analgesics. Blockade was performed bilaterally with 5 ml lidocaine (20 mg/ml) and 1 ml betamethasone (5 mg/ml). - RESULTS: the visual analogue scale before the procedure (VAS) was 8 for the first patient, 8 for the second and 9 for the third respectively, with the patients sitting (average 8.3). After 2 hours of GON blockade, the VAS was 1, 2 and 2 respectively (average 1.6). After 24 hours, the VAS was 0, 1 and 1 (average 0.6). No side effects were reported due to GON blockade. - CONCLUSION: in the cases in question, GON blockade showed good efficacy in the treatment of PDPH. The procedure is simple and quite safe. Although epidural blood patch is the definitive treatment for PDPH, GON blockade is an option to be considered for the treatment of these patients.
