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. 2025 Mar 9;17(3):e80289.
doi: 10.7759/cureus.80289. eCollection 2025 Mar.

The Effect of Bilateral Nasal Sphenopalatine Ganglion Block in Managing Headaches After Dural Puncture Following Lower Segment Cesarean Section: A Prospective Observational Study

Pushpraj Singh  1 , Tanmoy Ghatak  2 , Utsav Anand Mani  2 , Alka Verma  2 , Asif Dabeer Jafri  2   3 , Shyam Sundar  2 , Melissa Lourdes Carlos  4 , Malika Dhawal  5
Affiliations

The Effect of Bilateral Nasal Sphenopalatine Ganglion Block in Managing Headaches After Dural Puncture Following Lower Segment Cesarean Section: A Prospective Observational Study

Pushpraj Singh et al. Cureus. .

Abstract

Background: Post-dural puncture headache (PDPH) is a common complication that occurs in a small percentage of patients who undergo spinal or epidural anesthesia. The current treatment modalities for PDPH involve both conservative management and interventional approaches. In cases where conservative management is ineffective or if the symptoms are severe, interventional treatments are considered. The gold standard treatment for PDPH is the epidural blood patch (EBP). In recent years, minimally invasive interventions such as sphenopalatine ganglion block (SPGB) have been practiced, where a local anesthetic is injected into the sphenopalatine ganglion to block pain signals.

Objective: The primary objective of this study was to study the effectiveness of bilateral intranasal SPGB for the management of PDPH after lower segment cesarean section (LSCS).

Methods: Hundred parturients diagnosed to have PDPH were recruited into this prospective observational study. Patients were allocated to either of the two groups. Descriptive statistics, the chi-squared test, and Student's t-test were used for statistical analysis.

Results: The onset of analgesia in the SPGB group was 15 times faster than that of the conservatively treated control group. There was a reappearance of PDPH with a visual analogue scale(VAS) score >4 in three instances after SPGB.

Conclusion: SPGB is a very effective initial modality for managing severe headaches in patients with PDPH. Our study, beyond a reasonable doubt, indicates the excellent efficacy of SPGB over conservative management alone.

Keywords: epidural blood patch (ebp); lower segment cesarean section (lscs); post-dural puncture headache (pdph); sphenopalatine ganglion block (spgb); spinal and epidural anesthesia.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee of Baba Raghav Das Medical College, Gorakhpur issued approval 412/Ethics/2019. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. VAS monitoring
VAS: visual analogue scale
See this image and copyright information in PMC

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