Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials
Bloqueio transnasal do gânglio esfenopalatino para tratamento de cefaleia pós-punção dural: uma meta-análise de ensaios randomizados
Priyanka Dwivedi, Pratibha Singh, Tejas K. Patel, Vijeta Bajpai, Ankita Kabi, Yashpal Singh, Santosh Sharma, Surekha Kishore
Abstract
Objective
To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management.
Methods
A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach.
Results
After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with “very low” to “moderate” quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block.
Conclusion
Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH.
PROSPERO Registration
CRD42021291707.
Keywords
Resumo
Objetivo
Avaliar a eficácia e segurança do bloqueio transnasal do gânglio esfenopalatino (BTGEP) em relação a outros tratamentos para tratamento da cefaleia pós-punção dural (CPPD).
Métodos
Uma pesquisa sistemática da literatura foi realizada em bancos de dados de ensaios clínicos randomizados (ECR) comparando o bloqueio transnasal do GEP para o manejo da CPPD em relação a outras modalidades de tratamento. Todos os resultados foram agrupados usando o método Mantel-Haenszel e modelo de efeito aleatório. As análises de todos os resultados foram realizadas como um subgrupo com base no tipo de intervenções de controle (conservador, inalações intranasais de lidocaína, simulação e bloqueio do Nervo Occipital Maior [NOM]). A qualidade da evidência foi avaliada utilizando a abordagem GRADE.
Resultados
Após a triagem de 1.748 artigos relevantes, 9 ECRs comparando o bloqueio do GEP com outras intervenções (6 tratamentos conservadores, 1 placebo, 1 bloqueio NOM e 1 injeção intranasal de lidocaína) foram incluídos nesta meta-análise. O bloqueio GEP demonstrou superioridade sobre o tratamento conservador na redução da dor 30 min, 1 h, 2 h, 4 h após intervenções e falhas de tratamento com qualidade de evidência “muito baixa” a “moderada”. O bloqueio GEP não conseguiu demonstrar superioridade sobre o tratamento conservador na redução da dor além de 6 horas, necessidade de tratamento de resgate e eventos adversos. O bloqueio GEP demonstrou superioridade sobre a injeção intranasal de lidocaína na redução da dor 30 minutos, 1 hora, 6 horas e 24 horas após as intervenções. O bloqueio GEP não mostrou superioridade ou equivalência em todos os resultados de eficácia e segurança em comparação com o bloqueio simulado e o bloqueio NOM.
Conclusão
Evidências de qualidade muito baixa a moderada sugerem a superioridade do bloqueio SPG sobre o tratamento conservador e a inalação de lidocaína para alívio da dor em curto prazo da CPPD.
Cadastro PROSPERO
CRD42021291707.
Palavras-chave
References
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Submitted date:
01/12/2023
Accepted date:
06/27/2023
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