Greater occipital nerve block for postdural puncture headache (PDPH): A prospective audit of a modified guideline for the management of PDPH and review of the literature

• Published in: Journal of clinical anesthesia Vol. 26; no. 7; pp. 539 - 544
• Main Authors: Niraj, G., MD, FRCA, FFPMRCA, Kelkar, Aditi, MD, FRCA, Girotra, Vandana, FRCA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2014; Elsevier Limited
• Subjects: Adult; Analgesia, Epidural - adverse effects; Analgesia, Obstetrical - adverse effects; Anesthesia & Perioperative Care; Anesthetics, Local - administration & dosage; Audits; Blood Patch, Epidural; Consent; England; Female; Greater occipital nerve block; Headaches; Humans; Lidocaine - administration & dosage; Medical Audit - methods; Nerve Block - methods; Nerve Block - standards; Obstetrics; Pain Medicine; Patients; Post-Dural Puncture Headache - etiology; Post-Dural Puncture Headache - therapy; Postdural puncture headache; Practice Guidelines as Topic; Pregnancy; Prospective Studies; Severity of Illness Index; England; Postdural puncture headache; Greater occipital nerve block
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2014.03.006

Abstract Study Objective To perform a prospective audit of the modified guideline for the management postdural puncture headache (PDPH) and present the results at 6 months. Design Prospective single-center audit. Setting University hospital. Patients 24 adult, ASA physical status 1, 2, and 3 patients presenting with PDPH in both the obstetric and nonobstetric setting. Interventions Epidural blood patch (EBP) and bilateral greater occipital nerve blocks (GONB) were administered. Measurements Headache scores, nausea scores, presence and severity of neck stiffness, tinnitus, photophobia, and any complications with either technique. Results 24 patients were audited. Nineteen patients failed conservative management and were offered both GONB and EBP. One patient chose the EBP and was successfully treated. Of the 18 patients who received the GONB, headache resolved in 12 patients (66%). Six patients had a partial response to nerve block and were treated with an EBP. Conclusion Greater occipital nerve block with dexamethasone may have a role in the management of patients presenting with PDPH, who have failed conservative management. We present the results of our prospective audit and review the literature on GONB in the management of PDPH.