Adrenaline, Orthopedic, Post-Dural Puncture Headache, Randomized Controlled Study, Sphenopalatine Ganglion Block
Conditions
Brief summary
The aim of this study is to assess the efficacy, onset and duration of analgesia of sphenopalatine ganglion bock (SPGB) using lidocaine 4% with adrenaline as a treatment of postoperative Post dural puncture headache (PDPH) of orthopedic patients after lower limbs surgeries.
Interventions
PROCEDURESphenopalatine Ganglion Block
Sphenopalatine Ganglion Block will be performed by a transnasal approach. Few drops of lidocaine 2% will be instilled into both anterior nares. Then a cotton-tipped applicator soaked in 4% lignocaine & adrenaline (1 to 200000 will be passed through both the nares and the end of the applicator tip will be positioned just superior to the middle turbinate and anterior to the pterygopalatine fossa and sphenopalatine ganglion for 5 min with the patient in the supine position.
DRUGMedical Treatment
Patients will receive paracetamol 1 gm 6 hours daily intravenously for a day. If adequate pain relief will not be achieved, intravenous diclofenac 75 mg twice daily will be added.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Admitted to the orthopedic department * Complaining of criteria of severe post-dural puncture headache within 7 days following subarachnoid block used for lower limbs surgeries. * American Society of Anesthesiologists (ASA) physical status I and II.
Exclusion criteria
* Patient refusal or uncooperative. * Patients with uncontrollable hypertension. * Patient with known coagulopathy. * Patient with nasal septal deviation, polyp, history of nasal bleeding. * Patient with allergy to local anesthetics * American Society of Anesthesiologists physical status\>2.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Efficacy of analgesia demonstrated by visual analogue scale (VAS) less than 4 (effective) in the first 48 hours | 48 hours | Efficacy of analgesia demonstrated by visual analogue scale (VAS) less than 4 (effective) in the first 48 hours. VAS ranges from 0 to 10; 10 with worse outcome |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Onset of analgesia | 48 hours | The onset time till VAS≥ 4 |
| Duration of analgesia | 48 hours | Duration with VAS\< 4 |
| Adverse events | 48 hours | Local anesthetic toxicity, hypertension, postoperative epistaxis, cheek hematoma and hypoesthesia of the palate |
Outcome results
None listed