Greater Occipital Nerve Block Value in Management of Postdural Puncture Headache

Not Applicable

Completed

• Conditions: Postdural Puncture Headache
• Interventions: Procedure: Epidural Blood Patch; Procedure: Greater Occipital Nerve Block; Procedure: Bilateral suboccipital intramuscular injection; Drug: Normal Saline 10 mL Injection; Drug: Lidocaine 2% Injectable Solution

• Registration Number: NCT06380764
• Lead Sponsor: Benha University

Brief Summary

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.

Detailed Description

Not available

Study Timeline

• Study Start: 2023-03-02
• Primary Completion: 2023-07-25
• Study Completion: 2023-12-01
• Status Verified: 2024-04
• Study First Submitted: 2024-04-13
• Study First Submitted QC: 2024-04-18
• Last Update Submitted: 2024-04-18
• Study First Posted: 2024-04-24
• Last Update Posted: 2024-04-24

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 152

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.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Third line Group	Epidural Blood Patch	-
First line Group	Greater Occipital Nerve Block	-
Second line Group	Lidocaine 2% Injectable Solution	-
First line Group	Lidocaine 2% Injectable Solution	-
Second line Group	Bilateral suboccipital intramuscular injection	-
Placebo Group	Normal Saline 10 mL Injection	-

Primary Outcome Measures

Name	Time	Method
The extent of reduction of consumed analgesia	7 months	Necessity of greater occipital nerve block as a management procedure to the postural puncture headache

Trial Locations

Locations (1)

Benha university; 🇪🇬 Banhā, El Qalyoubia, Egypt