Central Nervous System Diseases Clinical Trial
Official title:
Effect of the Sphenopalatine Ganglion Block for Post Spinal Headache Treatment: A Prospective Randomized Controlled Study
This study evaluates effect of sphenopalatine ganglion block in post dural puncture headache. Half of participants will receive standard supportive treatment and other half of patients will be performed sphenopalatine ganglion block.
Spinal anesthesia is known subarachnoid block also commonly used regional anesthesia technic.
Spinal anesthesia is frequently performed in obstetric patients undergoing cesarian section,
which has several advantages including less deep vein thrombosis incidence, low opioid
requirement, early mobilization and early lactation also has some complications too.
Postdural headache is one of the most known complications of spinal anesthesia.
The etiology of the postspinal headache remains unclear. Severeness of the symptoms and
amount of the cerebrospinal fluid leakage have been found positive correlating. The
cerebrospinal fluid supports brain with it's mass effect. When a leakage of the fluid occurs,
support of the brain decreases and pain sensitive structures of the brain gets more
sensitive. In this condition 5 th 9th and 10 th cranial nerves, falks cerebelli, tentorium
and blood vessels are affected most. Decreased cerebrospinal fluid volume causes decreased
brain volume and compensatory mechanisms lead to cerebral venous dilatation. Conservative
treatments are iv hydration, analgesic agents, caffeine or theophylline. Epidural blood patch
is the gold standard for the treatment . However epidural blood patch is an invasive technic
and has some complications such as dural puncture, infection and neurologic trauma.
Sphenopalatine ganglion is one of the four parasympathetic thin ganglion in skull.
Parasympathetic fibers innervates cerebral and meningeal blood vessels which cause
vasodilatation and stimulate nociceptor activation on meninges. Consequently headache is
related with sensory cortex.
Transnasal SPG block is performed successfully in chronic pain syndromes including migraine,
cluster headaches and atypic face pain. Likewise the SPG block is performed in acute
treatment of postspinal headache. However gold standard of the treatment is epidural blood
patching which is interventional and has many risks. Several studies enrolled limited
participants offer SPG block primarily in the literature.
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