Peripheral Nerve Blocks for Postdural Puncture Headache: A New Solution for an Old Problem?

Abstract

Background/aim: Postdural puncture headache (PDPH) is one of the earliest recognized complications of regional anesthesia after inadvertent dural puncture. Epidural blood patch (EBP) is the "gold standard" for the treatment of PDPH. Several alternatives have been suggested as peripheral nerve blocks. The aim of this systematic review was to find out the potential efficacy and safety of peripheral nerve blocks for the treatment of PDPH.

Materials and methods: The main databases were systematically searched in September 2020 for studies examining regional anesthesia and PDPH.

Results: Nineteen studies were identified, including a total of 221 patients. Sphenopalatine ganglion block, greater occipital nerve block, and lesser occipital nerve block were performed. All participants reported a numeric rating scale (NRS) <4 after peripheral nerve blocks at 1, 24 and 48 h. Only patients with PDPH after diagnostic lumbar puncture reported NRS ≥4 after 48 h. No major adverse events were reported. Approximately, 17% of patients underwent a second or more peripheral nerve blocks. In 30 participants, EBP was required.

Conclusion: To our knowledge, this is the first systematic review on the use of peripheral nerve blocks to treat PDPH. Peripheral nerve blocks can be considered as analgesic options in the management of PDPH.

Keywords: Postdural puncture headache; greater occipital nerve block; lesser occipital nerve block; review; sphenopalatine ganglion block.

Figure 1. Flow diagram study selection process

Figure 2. Data distribution (Chauvenet’s criterion)