Headache, Post-Dural Puncture Clinical Trial
Official title:
COMPARATION BETWEEN SPHENOPALATINE BLOCK AND MULTIMODAL CLINICAL TREATMENT IN TREATMENT OF HEADACHE AFTER DURAL PUNCTION IN PREGNANT WOMEN.
Post-dural puncture headache leads to high morbidity and cost to the health system. Pregnant women have a higher incidence than other population groups. There are several treatments for post dural puncture headache mentioned in the literature, not all well established, with a wide heterogeneity of treatment between services. Sphenopalatine block then appears as an alternative treatment, having been described as effective in reports and case series, requiring comparative experimental studies.
Post-dural puncture headache leads to high morbidity and cost to the health system. Pregnant
women have a higher incidence than other population groups. There are several treatments for
post dural puncture headache mentioned in the literature, not all well established, with a
wide heterogeneity of treatment between services. Sphenopalatine block then appears as an
alternative treatment, having been described as effective in reports and case series,
requiring comparative experimental studies.
OBJECTIVES: To evaluate the efficacy of sphenopalatine blockade in combination with
multimodal treatment in reducing the incidence of epidural blood patch and pain intensity in
patients who develop headache after dural puncture, compared with the clinical treatment in
our service.
METHODS: A prospective randomized clinical, analytical study will be conducted at the
Obstetric Center of the Central Institute of the University of São Paulo School of Medicine
Hospital das Clínicas (ICHC-FMUSP). Women will be included who will undergo neuroaxis block
for cesarean section, vaginal delivery or uterine curettage, and who later present headache
after dural puncture, after evaluation and diagnosis by anesthesiologist. The patients will
be divided into three groups at random. In group I, patients will receive clinical treatment
according to the institution's old protocol for post dural puncture headache. In group II,
patients will receive clinical treatment, according to the new protocol of the institution.
In group III patients will receive clinical treatment, according to the new protocol of the
institution, associated with sphenopalatine block. They will be reevaluated after 12, 24 and
48 hours, and a visual analog scale will be applied to evaluate improvement. The pain will be
quantified before and after treatment. Pain intensity will be evaluated by verbal numerical
scale (EVN), incidence of need for epidural blood buffer in each group, as well as length of
hospital stay (in days).
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