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

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.

• Authors: Priyanka Dwivedi, Pratibha Singh, Tejas K Patel, Vijeta Bajpai, Ankita Kabi, Yashpal Singh, Santosh Sharma, Surekha Kishore
• Journal: Brazilian journal of anesthesiology (Elsevier) (Braz J Anesthesiol) 2023 Nov-Dec Vol. 73 Issue 6 Pg. 782-793 ISSN: 2352-2291 [Electronic] Brazil
• PMID: 37422191 (Publication Type: Meta-Analysis, Journal Article, Review)
• Copyright: Copyright © 2023 Sociedade Brasileira de Anestesiologia. Published by Elsevier España S.L.U. All rights reserved.

Chemical References

• Lidocaine

Topics

• Humans
• Sphenopalatine Ganglion Block (methods)
• Post-Dural Puncture Headache (therapy)
• Randomized Controlled Trials as Topic
• Pain
• Lidocaine