Post-dural puncture headache treated with grater occipital nerve block

Abstract

Introdution: post-dural puncture headache (PDPH) is an importante and relatively frequent complication after dural puncture. It is a intense pain that worsens when sitting or standing and improves when lying down. Epidural blood tamponade is the most effective treatment, but it is invasive. Objective is to demonstrate the results of greater occipital nerve (GON) block in the treatment of PDPH. Method: 3 patients after cesarean section with PDPH were evaluated. They agreed to  GON blockade after failure of hydration, bed rest and analgesics. Blockade was performed bilaterally with 2 ml of lidocaine (20 mg/ml) and 2 ml of dexametasone (2 mg/ml). Results: analogic visual scale (AVS) before the procedure was 8 for the first patient, 8 for the second and 9 for the third respectively, with the patients sitting (average 8.3). After 2 hours of GON blockade, the AVS was 1, 2 and 2 respectively (average 1.6). After 24 hours, the AVS was 0, 1 and 1 (average 0.6). No side effects were reported. Conclusion: in the cases in question, GON blockade showed good efficacy in the treatment of PDPH. The procedure is simple and quite safe. Although epidural blood patching is the definitive treatment for PDPH, GON blockade is an option  to be considered for the treatment of these patients.