The Effect of Bilateral Greater Occipital Nerve Block on the Treatment of Post-Dural Puncture Headache After Spinal Anesthesia in Cesarean Section: A Randomized Clinical Trial

One of the annoying side effects of spinal anesthesia in cesarean section surgery is the post-dural puncture headache (PDPH) which occurs 2 to 5 days after the surgery. The aim of this study was to examine the effect of bilateral occipital nerve block (GONB) in the treatment of PDPH after cesarean section surgery. In this randomized clinical trial, 74 pregnant women who underwent cesarean section with spinal anesthesia in 2017 and referred to Rafsanjan Pain Clinic with PDPH, were randomly assigned into two groups of 37. In the first group, GONB treatment was done by bupivacaine and dexamethasone and the second group received oral drug treatment with acetaminophen and pregabalin. Patients in either group were evaluated for headache severity before intervention, 1, 6 and 24 hours after intervention. Data was analyzed using two-way repeated measures ANOVA. The results of the statistical test showed that the interaction effect of the type of treatment and the time of the evaluation of the headache was statistically significant (F=130.912, p<0.001). This means that the rate of headache reduction during the study period was significantly higher in the GONB group than in the oral treatment ones. According to the results, despite the effectiveness of both therapies, the effect of GONB on reducing headache severity was greater than that of medication. It seems that GONB can be used as an effective alternative to PDPH treatment.