Sphenopalatine Ganglion Block for Postdural Puncture Headache in the Emergency Department
Postdural Puncture Headache
About this trial
This is an interventional other trial for Postdural Puncture Headache
Eligibility Criteria
Inclusion Criteria:
- Active postdural puncture headache within 7 days after diagnostic lumbar puncture
- Age ≥ 18 years.
- American Society of Anesthesiologists (ASA) physical status ≤ 3
Exclusion Criteria:
- Known coagulopathy
- Known nasal septal deviation or abnormalities
- Medical conditions contraindicated to lidocaine or bupivacaine
Sites / Locations
- University of Arkansas for Medical Sciences
Arms of the Study
Arm 1
Arm 2
Active Comparator
Placebo Comparator
Sphenopalatine Ganglion Block
Placebo
Subjects will be asked to blow out each nostril. They will then be laid supine with a small shoulder roll and intranasal phenylephrine 0.25% (RhinallⓇ) will be sprayed once into each nostril to preemptively minimize bleeding. Sphenopalatine ganglion block will be performed by inserting long cotton tipped applicators saturated in 2% viscous lidocaine into nostril until properly seated in the posterior nasopharynx. These will be left in place for 10 minutes and then 1 mililiter of 0.5% bupivacaine will be administered down the plastic hollow shaft of each applicator via an 18g angiocatheter. The applicators will remain in place for 10 more minutes and then be removed.
Subjects will be asked to blow out each nostril. They will then be laid supine with a small shoulder roll and intranasal phenylephrine 0.25% (RhinallⓇ) will be sprayed once into each nostril to preemptively minimize bleeding. SPGB will be performed by inserting long cotton tipped applicators saturated in carboxymethylcellulose based lubricant (i.e. K-Y Jelly®) into nostril until properly seated in the posterior nasopharynx. These will be left in place for 10 minutes and then 1 mililiter of normal saline will be administered down the plastic hollow shaft of each applicator via an 18g angiocatheter. The applicators will remain in place for 10 more minutes and then be removed.