الفهرس 
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Abstract
Post-Dural Puncture Headache (PDPH) is a complication associated with spinal anesthesia. While conventional treatments are available, the Epidural Blood Patch (EBP) is considered the gold standard. Other less invasive interventions, such as Sphenopalatine Ganglion (SPG) block and Greater Occipital Nerve (GON) block, have also been used to treat PDPH. The trans-nasal approach is a non-invasive, low-risk technique that can be performed at the bedside without imaging tools.
The Lesser Occipital Nerve Block (LONB) is often used in conjunction with the GONB to address headaches in the lateral occipital region.
This study aims to compare the efficacy of trans-nasal sphenopalatine ganglion block (TNSGB) versus Greater and Lesser Occipital Nerve Block (GALONB) guided by ultrasound in relieving PDPH and its symptoms, as well as to assess patient satisfaction with the interventions.
Conducted at Ain Shams University Hospitals with approval from the medical ethical committee, the study included 50 participants (25 per group) who were ASA class I or II candidates for spinal anesthesia undergoing elective lower abdominal surgeries. Participants were randomly assigned to two groups:
• group TNSGB: Received a trans-nasal sphenopalatine ganglion block using cotton-tipped applicators inserted trans-nasally until positioned in the posterior nasopharynx.
• group GALONB: Received a Greater and Lesser Occipital Nerve Block under ultrasound guidance to identify nerves, foramina, vascular structures, and their course.
Patient satisfaction was evaluated using a 5-point Likert scale. The analgesic efficacy of TNSGB versus GALONB was assessed using a Numeric Rating Scale (NRS) at 0, 30 minutes, 1, 2, 3, 6, 12, 24, and 48 hours after treatment.
Adverse events, the need for rescue analgesia, and other therapeutic interventions were also recorded.
The study results indicated that the mean pain score (NRS) was non-significantly lower in the TNSGB group compared to the GALONB group at all time points, with reduced need for EBP and rescue analgesia, suggesting better analgesia quality.
Additionally, the TNSGB group had a higher number of very satisfied patients compared to the GALONB group. The incidence of complications was statistically similar between the two groups.
In conclusion, both GALONB and TNSGB techniques are simple to perform and carry minimal risk of serious complications. They are equally effective in relieving PDPH and its associated symptoms, as evidenced by reduced pain scores, minimal need for rescue analgesia, and high patient satisfaction.