Cameron R Smith1, W Christopher Fox2, Christopher P Robinson2,3, Cynthia Garvan1, Marc-Alain Babi2,3, Michael A Pizzi2,3, Erica Lobmeyer1, Alberto Bursian1, Carolina B Maciel2,3, Katharina M Busl4,5. 1. Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA. 2. Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, 1149 Newell Drive, L3-100, Gainesville, FL, 32610, USA. 3. Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA. 4. Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, 1149 Newell Drive, L3-100, Gainesville, FL, 32610, USA. k.busl@ufl.edu. 5. Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA. k.busl@ufl.edu.
Abstract
BACKGROUND: Severe headache is a hallmark clinical feature of spontaneous subarachnoid hemorrhage (SAH), affecting nearly 90% of patients during index hospitalization, regardless of the SAH severity or presence of a culprit aneurysm. Up to 1 in 4 survivors of SAH experience chronic headaches, which may be severe and last for years. Data guiding the optimal management of post-SAH headache are lacking. Opioids, often in escalating doses, remain the guideline-recommended mainstay of acute therapy, but pain relief remains suboptimal. METHODS: This study is a case series of adult patients who received bilateral pterygopalatine fossa (PPF) blockade for the management of refractory headaches after spontaneous SAH (aneurysmal and non-aneurysmal) at a single tertiary care center. We examined pain scores and analgesic requirements before and after block placement. RESULTS: Seven patients (median age 54 years, 3 men, four aneurysmal and three non-aneurysmal) received a PPF-block between post-bleed day 6-11 during index hospitalization in the neurointensive care unit. The worst pain recorded in the 24-h period before the block was significantly higher than in the period 4 h after the block (9.1 vs. 3.1; p = 0.0156), and in the period 8 h after the block (9.1 vs. 2.8; p = 0.0313). The only complication was minor oozing from the needle insertion sites, which subsided completely with gauze pressure within 1 min. CONCLUSIONS: PPF blockade might constitute a promising opioid-sparing therapeutic strategy for the management of post-SAH headache that merits further prospective controlled randomized studies.
BACKGROUND: Severe headache is a hallmark clinical feature of spontaneous subarachnoid hemorrhage (SAH), affecting nearly 90% of patients during index hospitalization, regardless of the SAH severity or presence of a culprit aneurysm. Up to 1 in 4 survivors of SAH experience chronic headaches, which may be severe and last for years. Data guiding the optimal management of post-SAH headache are lacking. Opioids, often in escalating doses, remain the guideline-recommended mainstay of acute therapy, but pain relief remains suboptimal. METHODS: This study is a case series of adult patients who received bilateral pterygopalatine fossa (PPF) blockade for the management of refractory headaches after spontaneous SAH (aneurysmal and non-aneurysmal) at a single tertiary care center. We examined pain scores and analgesic requirements before and after block placement. RESULTS: Seven patients (median age 54 years, 3 men, four aneurysmal and three non-aneurysmal) received a PPF-block between post-bleed day 6-11 during index hospitalization in the neurointensive care unit. The worst pain recorded in the 24-h period before the block was significantly higher than in the period 4 h after the block (9.1 vs. 3.1; p = 0.0156), and in the period 8 h after the block (9.1 vs. 2.8; p = 0.0313). The only complication was minor oozing from the needle insertion sites, which subsided completely with gauze pressure within 1 min. CONCLUSIONS: PPF blockade might constitute a promising opioid-sparing therapeutic strategy for the management of post-SAH headache that merits further prospective controlled randomized studies.
Authors: Robert S Eisinger; Zachary A Sorrentino; Brandon Lucke-Wold; Sonya Zhou; Brooke Barlow; Brian Hoh; Carolina B Maciel; Katharina M Busl Journal: Brain Inj Date: 2022-03-30 Impact factor: 2.167