Postdural Puncture Headache Relief With Aminophylline and SPGB

Trans-nasal Sphenopalatine Ganglion Block Versus Intravenous Aminophylline Injection for Treatment of Postdural Puncture Headache After Caesarean Section Under Spinal Anesthesia

The purpose of the study is to compare Sphenopalatine ganglion block (SPGB) and aminophylline in the efficacy and safety management of PDPH.

Postdural puncture headache (PDPH) is a severe and debilitating complication after regional anesthesia in the obstetric population; The gold standard treatment for PDPH is epidural blood patch, which is an invasive and risky procedure.

The trans-nasal sphenopalatine ganglion (SPG) block and intravenous aminophylline are promising options for PDPH. So the investigators designed this randomized, double-blind study to compare Sphenopalatine ganglion block (SPGB) and aminophylline in the efficacy and safety management of PDPH.

Inclusion Criteria:

• 18 - 40 years old female.

• ASA I -II according to the American society of anesthesiologists.

• Spinal anesthesia with 22G Quincke needle for cesarean section.

• PDPH was defined according to the international classification of headache disorders, 3rd edition criteria (ICHD-3) as:

  • Headache occurring within 5 days of a lumbar puncture.
  • Orthostatic headache that significantly worsens soon after sitting upright or standing and/or improves after lying horizontally usually accompanied by neck pain, tinnitus, changes in hearing, photophobia, and/or nausea.
  • Exclusion of other causes such as hypertension, preeclampsia, tension headache, migraine, etc.

Exclusion Criteria:

• A history of headaches that could interfere with the PDPH diagnosis,
• A history of central nervous system diseases, including intracranial hemorrhage, seizures, intracranial hypertension, or hydrocephalus
• A history of cardiovascular diseases, including coronary heart disease, arrhythmias, or hypertension.
• A history of allergy to or any contraindication for using Aminophylline.
• Coagulopathy.
• Nasal septal deviation, polyp, or nasal bleeding.
• General anesthesia after failed spinal anesthesia.