Complications possibly related to the sphenopalatine ganglion block in the treatment of postdural puncture headache: Series of cases

Accidental puncture of the dura is a known complication during epidural anesthesia. It often causes postdural headache and eventually other symptoms such as nausea, vomiting, neck stiffness and tinnitus. Rarely, cranial nerve palsy, cerebral venous thrombosis, or other complications may occur. We will report a series of cases of patients with postdural puncture headache (PDPH), who developed complications possibly associated with sphenopalatine ganglion block (SPGB). In one patient, despite the improvement of headache, there was worsening of diplopia and photophobia. In the other two patients in which SPGB was performed, it occurred an important improvement of pain, however, they evolved with recurrence of headache, requiring the execution of a new SPGB with important pain improvement. Indeed on the twelfth postoperative day they evolved with seizures and cerebral venous thrombosis was diagnosed. The treatment of PDPH with SPGB has been shown to be effective for the improvement of the headache symptom, but it does not act on a probable etiology of the pain which would be the intracranial hypotension due to the cerebrospinal fluid leak. The improvement of the symptom allows the patient to remain in the orthostatic position, which can worsen the traction of cranial nerves and aggravate the repercussions, favoring cerebral venous thrombosis. (author)