Efficacy of bilateral greater occipital nerve block in postdural puncture headache: a narrative review

The Epidural blood patch is considered the gold standard for managing postdural puncture headache when supportive measures fail. However, it is a procedure which can lead to another inadvertent dural puncture. Other potential adverse events that could occur during a blood patch are meningitis, neurological deficits, and unconsciousness. The bilateral greater occipital nerve block has been used for treating chronic headaches in patients with PDPH with a single injection. This minimally invasive, simple procedure can be considered for patients early, along with other supportive treatment, and an epidural blood patch can be avoided.

Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy

The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block has been used for a long time for treating headaches of varying etiologies. For anesthesiologists, treating postdural puncture headaches (PDPH) has always been challenging. The epidural block patch (EBP) was the only option until researchers explored the role of the SPG block as a relatively simple and effective way to treat PDPH. Also, since the existing evidence proving the efficacy of the SPG block in PDPH is scarce, the block cannot be offered to all patients. EBP can be still considered if an SPG block is not able to alleviate pain due to PDPH.

Perioperative cardiac arrest: teamwork and management

Perioperative cardiac arrest is an unfortunate event that can have disastrous outcomes if not attended and intervened on time. Arrests occurring intraoperatively have usually good outcomes as the patient is continuously monitored and it is easy to find out the cause of cardiac arrest. Patients coming for emergency surgeries, advanced ASA physical status, extremes of age groups [geriatric, pediatric] are the candidates in which perioperative cardiac arrest occurs. Events precipitating cardiac arrests should be identified early in wards. However once an arrest occurs in wards, the overall outcome depends on the timing, efforts of the resuscitation team and the events leading to cardiac arrest

Postoperative rate induced left bundle branch block after craniotomy

Rate induced left bundle branch block [LBBB] is a rare peri-operative phenomenon. We encountered rate related LBBB in a 72 year old patient who had undergone a craniotomy. Acute coronary event was ruled out by doing serial troponin-I levels and absence of new onset regional wall motion abnormalities on echocardiogram. The electrocardiographic changes reverted to normal after controlling the rate with beta blockers. Further cardiac evaluation was advised but the patient and family opted for a conservative medical management considering his age and co-morbidities