Authors: Vakhtang Shoshiashvili.
Postdural puncture headache (PDPH) is a major complication of neuraxial anesthesia that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design, and the technique used also affect the risk. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing, and improves with lying down. Conservative therapies such as bed rest, hydration, and caffeine are commonly used as prophylaxis and treatment for this condition.
We are presenting a case report of PDPH after pilonidal cystectomy. The patient was a 23 years old male, nonsmoker. Spinal puncture – with BBraun Spinocan 25 G Quincke type needle on the L3-4 level. 5 minutes later after injecting of 3.5 ml Marcaine (“Astra Zeneca”) there was an acceptable depth of spinal anesthesia. Surgery and anesthesia – without complication. On second day patient was ambulated at home, no headaches. On third day after surgery patient felt severe postural headache. Hydration and caffeine was not helpful. We decided to relieve this pain condition by the bilateral sphenopalatine ganglion block with 0.5 ml 2% lidocaine application through the transnasal cotton ended catheter-stick. Pain relieved immediately. Duration of the application 5 minutes. Procedure was repeated with 1 h. intervals three times. PDPH relieved completely.
We are concluding that sphenopalatine ganglion block with transnasal 2% lidocain application is a simple, effective and safe tool for PDPH treatment, which is usable for ambulated patients.
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