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publication name Single or Double Bilateral Greater Occipital Nerve Blocks to manage Headache after Spinal Obstetric Anesthesia
Authors Ahmed M Salem,Ahmed E Salem,Amr Sharaf Eldin,Ahmed M Hagras
year 2019
keywords Spinal anesthesia; Cesarean section; Post dural punctures headache; Greater occipital nerve block; Single distal block; Double distal and proximal block
journal Journal of Anthesia & Intensive care Medicine
volume 8
issue 4
pages 7
publisher journal of Anthesia & intensive care
Local/International International
Paper Link Not Available
Full paper download
Supplementary materials Not Available
Abstract

Objectives: To evaluate outcome of bilateral Greater Occipital Nerve Block (GONB) for parturient had Cesarean Section (CS) under Spinal Anesthesia (SA) for management of post-Dural puncture headache (PDPH). Patients & Methods: PDPH severity was graded using modified Lybecker classification as mild, moderate or severe. Mild PDPH was managed conservatively at home. Patients had moderate, severe headache or persistent mild PDPH within 3-day undertook bilateral distal GONB (2% lidocaine and 0.5% bupivacaine; 1:1 mixture) at junction of medial third and lateral two-thirds of line joining External Occipital Protuberance (EOP) to mastoid process. Patients who had minimal or still had moderate improvement on distal block, received proximal GONB at 3-cm below and 1.5-cm lateral to EOP. Pain was scored using the numerical pain scale pre- and 3-hr post procedure, 1 and 4 weeks thereafter. Patients had minimal improvement on proximal block or recurred pain severity had Epidural Blood Patch (EBP). Results: 119 women (19.4%) developed PDPH; 87 had mild PDPH and received conservative management that resulted in 4-wk success rate of 56.4%. Patients with moderate and severe and mild PDPH that failed to respond to conservative management undertook distal GONB that showed primary, 1-wk and 4-wk success rates of 82.9%, 64.3% and 61.4%, respectively. 25 patients undertook proximal block for success rate of 78%. Conclusion: Bilateral GONB is simple, minimally invasive, safe and efficient therapeutic modality for moderate, severe and mild headache resistant to conservative treatment. Double, distal and proximal, block reduced the need for EBP down to 11.4%.

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