Trans-Nasal Sphenopalatine Ganglion Block Versus Intravenous Aminophylline Injection for Treating Postdural Puncture Headache After Cesarean Section Under Spinal Anesthesia

Background: Postdural puncture headache (PDPH) is a severe and debilitating complication in the obstetric population after regional anesthesia. It affects the parturient and delays home discharge. The epidural blood patch (EBP) is the gold standard treatment; however, it is an invasive and risky procedure. The trans-nasal sphenopalatine ganglion block (SPGB) and intravenous aminophylline are promising modalities for PDPH treatment. Materials and Methods: In a prospective, double-blinded, and controlled trial, Seventy-five obstetric participants (ASA I and II, aged 18 to 40 years) complaining of PDPH within five days after spinal anesthesia for cesarean section using 22G Quincke needle) were randomized into three groups. Group C received conservative therapy, Group A received intravenous aminophylline plus conservative therapy, and Group S received trans-nasal SPGB plus conservative therapy. Headache severity (VAS score), patient global impression of change (PGIC) scale and the incidence of adverse events were recorded. Results: Showed that SPGB and intravenous aminophylline significantly reduced the median values of VAS (at 30 minutes,1, 6, 12, and 24 hours) with P?0.001 and improved 24-hour PGIC with P?0.001 compared to control. Moreover, SPGB significantly reduced VAS at 30 minutes compared to aminophylline with P=0.004; No significant differences in adverse events. Conclusion: It is reasonable to offer trans-nasal SPGB, intravenous aminophylline, and conservative therapy as simple, safe, and non-invasive modalities for treating PDPH before EBP.