Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations

• Published in: Brazilian journal of anesthesiology (Elsevier) 2016-09, Vol.66 (5), p.445-450
• Main Authors: Uyar Türkyilmaz, Esra, Camgöz Eryilmaz, Nuray, Aydin Güzey, Nihan, Moraloğlu, Özlem
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia, Obstetrical; Anesthesia, Spinal; ANESTHESIOLOGY; Anesthetics, Local - administration & dosage; Anesthetics, Local - therapeutic use; Blood Patch, Epidural; Bloqueio do NOM; Bupivacaine - administration & dosage; Bupivacaine - analogs & derivatives; Bupivacaine - therapeutic use; Caesarean operations; Cefaléia pós-punção dural; Cesarean Section - adverse effects; Cesarean Section - methods; Cesarianas; Cranial Nerves; Dexamethasone - administration & dosage; Dexamethasone - therapeutic use; Female; GON block; Humans; Nerve Block - methods; Pain Measurement; Post-dural puncture headache; Post-Dural Puncture Headache - drug therapy; Pregnancy; Retrospective Studies
• ISSN: 0104-0014; 1806-907X; 0104-0014
• DOI: 10.1016/j.bjane.2015.03.004

Post-dural puncture headache (PDPH) is an important complication of neuroaxial anesthesia and more frequently noted in pregnant women. The pain is described as severe, disturbing and its location is usually fronto-occipital. The conservative treatment of PDPH consists of bed rest, fluid theraphy, analgesics and caffeine. Epidural blood patch is gold standard theraphy but it is an invasive method. The greater occipital nerve (GON) is formed of sensory fibers that originate in the C2 and C3 segments of the spinal cord and it is the main sensory nerve of the occipital region. GON blockage has been used for the treatment of many kinds of headache. The aim of this retrospective study is to present the results of PDPH treated with GON block over 1 year period in our institute. 16 patients who had been diagnosed to have PDPH, and performed GON block after caesarean operations were included in the study. GON blocks were performed as the first treatment directly after diagnose of the PDPH with levobupivacaine and dexamethasone. The mean VAS score of the patients was 8.75 (±0.93) before the block; 3.87 (±1.78) 10min after the block; 1.18 (±2.04) 2h after the block and 2.13 (±1.64) 24h after the block. No adverse effects were observed. Treatment of PDPH with GON block seems to be a minimal invasive, easy and effective method especially after caesarean operations. A GON block may be considered before the application of a blood patch. A cefaleia pós-punção dural (CPPD) é uma complicação importante da anestesia neuroaxial e mais frequentemente observada em mulheres grávidas. A dor é descrita como intensa, perturbadora, e sua localização é geralmente fronto-occipital. O tratamento conservador da CPPD consiste em repouso no leito, fluidoterapia, analgésicos e cafeína. O tampão sanguíneo peridural é o padrão ouro de tratamento, mas é um método invasivo. O nervo occipital maior (NOM) é formado por fibras sensoriais com origem nos segmentos C2 e C3da medula espinhal e é o principal nervo sensorial da região occipital. O bloqueio do NOM tem sido usado para o tratamento de muitos tipos de dor de cabeça. O objetivo deste estudo retrospectivo foi apresentar os resultados de CPPD tratada com bloqueio do NOM no período de um ano em nosso instituto. 16 pacientes que foram diagnosticadas com CPPD e submetidas a bloqueio de NOM após cesariana foram incluídas no estudo. Os bloqueios do NOM foram realizados como o primeiro tratamento imediatamente após o diagnóstico de CPPD com levobup