Sphenopalatine Ganglion Nerve Block for Postdural Puncture Headache in Obstetrics
| Status: | Withdrawn |
|---|---|
| Conditions: | Migraine Headaches, Hospital |
| Therapuetic Areas: | Neurology, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 2/14/2019 |
| Start Date: | April 17, 2018 |
| End Date: | January 30, 2019 |
During labor and delivery, pregnant women may choose to receive pain relief called epidural
analgesia, which is the delivery of a numbing agent through the back and into a body space
around the spinal column. This numbs the area of the stomach and the pelvis. Typically the
numbing agent is lidocaine, which is a local anesthetic like your dentist uses. Some times
the numbing agent is combined with another medication that causes drowsiness and relieves
pain called a narcotic. One of the risks associated with having this kind of pain relief is
unintentional puncture of a sheath of tissue that surrounds and protects the spinal cord when
inserting the needle. This sheath is called the dura. This would cause the fluid surrounding
the spinal cord to leak out and this would cause a headache. This headache is called a
post-dural puncture headache [PDPH]. The headache can be mild or severe. Rarely, PDPH can be
serious and cause bleeding or small clots in the brain and damage to nerves that come out of
the brain.
The purpose of this study is to test the use of a technique that uses a hollow cotton swab
[no needles] to numb a nerve cell cluster that sits at the very back of the nasal cavity. The
anatomical name for this nerve cell cluster is the sphenopalatine ganglion. This has been
done before at BJH and other hospitals with positive results, but no formal studies have been
conducted here. Also, the sphenopalatine ganglion [SPG] has been the treatment target for
other kinds of headaches. To numb the SPG, a hollow tip cotton swab [like a long Q-Tip] is
inserted through the nose to the back of the nasal cavity and a solution of numbing agent is
slowly pumped through the hollow Q-tip. This study will include a group that will receive a
salt solution through the swab instead of a numbing agent. Subjects will be offered BJH
standard care for their headache if they do not have relief from the study procedures.
Standard care would be decided by their treating physician and may include oral pain
medications and/or medications like ibuprofen [Motrin] or they could have a procedure called
an epidural blood patch. This is performed by injecting a small amount of the patient's own
blood into the areas of the spinal column where the original epidural anesthesia was injected
in order to "patch" the leaks in the dura.
analgesia, which is the delivery of a numbing agent through the back and into a body space
around the spinal column. This numbs the area of the stomach and the pelvis. Typically the
numbing agent is lidocaine, which is a local anesthetic like your dentist uses. Some times
the numbing agent is combined with another medication that causes drowsiness and relieves
pain called a narcotic. One of the risks associated with having this kind of pain relief is
unintentional puncture of a sheath of tissue that surrounds and protects the spinal cord when
inserting the needle. This sheath is called the dura. This would cause the fluid surrounding
the spinal cord to leak out and this would cause a headache. This headache is called a
post-dural puncture headache [PDPH]. The headache can be mild or severe. Rarely, PDPH can be
serious and cause bleeding or small clots in the brain and damage to nerves that come out of
the brain.
The purpose of this study is to test the use of a technique that uses a hollow cotton swab
[no needles] to numb a nerve cell cluster that sits at the very back of the nasal cavity. The
anatomical name for this nerve cell cluster is the sphenopalatine ganglion. This has been
done before at BJH and other hospitals with positive results, but no formal studies have been
conducted here. Also, the sphenopalatine ganglion [SPG] has been the treatment target for
other kinds of headaches. To numb the SPG, a hollow tip cotton swab [like a long Q-Tip] is
inserted through the nose to the back of the nasal cavity and a solution of numbing agent is
slowly pumped through the hollow Q-tip. This study will include a group that will receive a
salt solution through the swab instead of a numbing agent. Subjects will be offered BJH
standard care for their headache if they do not have relief from the study procedures.
Standard care would be decided by their treating physician and may include oral pain
medications and/or medications like ibuprofen [Motrin] or they could have a procedure called
an epidural blood patch. This is performed by injecting a small amount of the patient's own
blood into the areas of the spinal column where the original epidural anesthesia was injected
in order to "patch" the leaks in the dura.
Inclusion Criteria:
- A parturient who received an epidural or CSE for either labor or cesarean delivery -
including attempted epidural; irrespective of whether a diagnosis of inadvertent
spinal was noted at the time.
- A patient complaining of symptoms of postural headache consistent with postdural
puncture headache. This is defined by the ICHD-II (International Classification of
Headache Disorders-II) as one of the following symptoms to be present: headache, neck
stiffness, tinnitus, hypoacusis (auditory deficit), photophobia, or nausea - symptoms
which occur within 15 minutes of moving to an upright position (sitting or standing)
and resolving within 15 minutes of moving to the supine position.
Exclusion Criteria:
- Single-shot spinal anesthesia (unless an epidural was attempted).
- Epidural performed for non-obstetric indications.
- Patient with a clinically suspected diagnosis of meningitis, intracranial hemorrhage
or venous thrombosis - unless these have been excluded by neurological assessment
and/or imaging as appropriate for normal clinical management.
- Symptoms or signs of cranial nerve palsy: e.g., diplopia.
- Contraindication to performance of epidural blood patch.
- Patient refusal or inability to understand consent.
We found this trial at
1
site
Saint Louis, Missouri 63110
Phone: 314-362-2264
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