Greater Occipital Nerve Block Value in Management of Postdural Puncture Headache

Greater Occipital Nerve Block at Two-levels Spares the Need for Epidural Blood Patch for Management of Postdural Puncture Headache

Neuraxial techniques are well tolerated and effective options for labor analgesia and anesthesia for caesarean section, and may protect high risk women against severe maternal morbidity. However, neuraxial techniques still have drawbacks especially postdural puncture headache (PDPH) and may be associated with chronic headache, back pain and postnatal depression. PDPH is a relatively common acute complication of neuraxial techniques that was traditionally considered benign and self-limiting, but it significantly impacts patients' general health and quality of life.

Greater Occipital Nerve (GON) originates from C2-3 segments and through its muscular relations it is divided as proximal and distal parts; the most proximal part lies between obliquus capitis inferior and semispinalis and then passes through the semispinalis to pierce the trapezius muscle. In distal region of trapezius fascia, the GON is crossed by the occipital artery and exits the trapezius fascia into the nuchal line about 5-cm lateral to midline. Functionally, GON provides motor supplies to the muscles while passing through it and its main sensory supply is in the occipital region.

Inclusion Criteria:

• Patients with postdural puncture headache;
• Patients partially improved on conservative treatment and required a definitive pain relieving management;
• Patients who were intolerant to conventional analgesics;
• Patients who did not receive or did not improve on conservative therapies.

Exclusion Criteria:

• Patients had postdural puncture headache who were improving on conservative treatment and refused further interventions;
• Patients who had headache secondary to local or systemic disease, cervical radiculopathy, manifest diabetes mellitus;
• Patients dependent on routine analgesia for other causes were excluded from the study;
• Patients refused to participate in the study or to sign the written consent;
• Patients missed during follow-up were not included in the study.