trans-nasal sphenopalatine ganglion block versus intravenous aminophylline injection for treating postdural puncture headache after cesarean section under spinal anesthesia

Background: postdural puncture headache (pdph) is a severe and debilitating complication in the obstetric population after regional anesthesia. it affects the parturient and delays home discharge. the epidural blood patch (ebp) is the gold standard treatment; however, it is an invasive and risky procedure. the trans-nasal sphenopalatine ganglion block (spgb) and intravenous aminophylline are promising modalities for pdph treatment. materials and methods: in a prospective, double-blinded, and controlled trial, seventy-five obstetric participants (asa i and ii, aged 18 to 40 years) complaining of pdph within five days after spinal anesthesia for cesarean section using 22g quincke needle) were randomized into three groups. group c received conservative therapy, group a received intravenous aminophylline plus conservative therapy, and group s received trans-nasal spgb plus conservative therapy. headache severity (vas score), patient global impression of change (pgic) scale and the incidence of adverse events were recorded. results: showed that spgb and intravenous aminophylline significantly reduced the median values of vas (at 30 minutes,1, 6, 12, and 24 hours) with p?0.001 and improved 24-hour pgic with p?0.001 compared to control. moreover, spgb significantly reduced vas at 30 minutes compared to aminophylline with p=0.004; no significant differences in adverse events. conclusion: it is reasonable to offer trans-nasal spgb, intravenous aminophylline, and conservative therapy as simple, safe, and non-invasive modalities for treating pdph before ebp.