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Review
. 2023 Nov-Dec;73(6):782-793.
doi: 10.1016/j.bjane.2023.06.002. Epub 2023 Jul 6.

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Priyanka Dwivedi  1 , Pratibha Singh  1 , Tejas K Patel  2 , Vijeta Bajpai  1 , Ankita Kabi  1 , Yashpal Singh  3 , Santosh Sharma  4 , Surekha Kishore  5
Affiliations
Review

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Priyanka Dwivedi et al. Braz J Anesthesiol. 2023 Nov-Dec.

Abstract

Objective: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management.

Methods: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach.

Results: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with "very low" to "moderate" quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block.

Conclusion: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH.

Prospero registration: CRD42021291707.

Keywords: Conservative treatment; Headache; Pain management; Post-dural puncture headache; Sphenopalatine ganglion block.

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Conflict of interest statement

Conflicts of interest The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram showing the study selection process.
Figure 2
Figure 2
Forest plot of the outcome pain score at 30-min after intervention.
Figure 3
Figure 3
Forest plot of the outcome pain score at 2 hours after intervention.
Figure 4
Figure 4
Forest plot of the outcome pain score at 4 hours after intervention.
See this image and copyright information in PMC

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