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%. |
