A Novel NAG (Nerve And Ganglion) Dual Block For PDPH: An Observational Study In Seven Patients Of Refractory Post Dural Puncture Headache (PDPH) Using Combined Greater Occipital Nerve (GON) And Sphenopalatine Ganglion (SPG) Blocks


Vol 5 | Issue 1 | Jan-April 2019 | page: 11-13 | Sunil Malik, Shiv Kumar Singh

Authors: Sunil Malik [1], Shiv Kumar Singh [2].

[1] Department of Anesthesiology, Manipal Hospitals, Dwarka, New Delhi, India.
[2] Department of Anaesthesia 11th Floor, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.

Address of Correspondence

Dr. Sunil Malik,
DNB, B-33 Vishal Enclave, New Delhi 110027, India
E-Mail: drsunilmalik@yahoo.co.in


Objective: Managing Post Dural Puncture Headache (PDPH) is a challenge for most anesthesiologist as the gold standard, epidural blood patch (EBP) itself can lead to Dural Puncture that caused the complication in the first place. Medical management of PDPH may not provide symptomatic relief and anesthesiologists are on a constant lookout for techniques that can provide instant and sustained relief from this debilitating complication. Sphenopalatine Ganglion (SPG) and Greater Occipital Nerve (GON) Block have been used individually to manage PDPH in a selected number of patients. For the first time in the literature, we propose the use of a less invasive and acceptable technique using both these blocks (combined nerve and ganglion block) in the same patient to provide higher success rates. The hypothesis for this NAG Dual Block is because both these blocks act on two important but different paths in the pathogenesis of PDPH. In this case series, we describe our experience in 7 patients with PDPH who consented for the dual block.
Case Series: We describe the successful use of NAG dual block in seven patients with PDPH who had immediate and sustained relief. The patients were followed up for up to 48hrs.
Conclusions: We recommend combining both the blocks that are less invasive than EBP for managing PDPH. The Superiority of this new technique will need more data either by RCTs or larger case series. Along with ongoing supportive medical management, both these blocks can be offered as a rescue to all patients diagnosed with moderate to severe PDPH.
Keywords: NAG (Nerve And Ganglion), Post Dural Puncture Headache (PDPH), Greater Occipital Nerve (GON), Sphenopalatine Ganglion (SPG).


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How to Cite this Article: Malik S, Singh S K. A Novel NAG (Nerve And Ganglion) Dual Block For PDPH: An Observational Study In Seven Patients Of Refractory Post Dural Puncture Headache (PDPH) Using Combined Greater Occipital Nerve (GON) And Sphenopalatine Ganglion (SPG) Blocks. Journal of Anaesthesia and Critical Care Case Reports Jan-April 2019;5(1):14-17.  

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