Transnasal Sphenopalatine Ganglion Block for Rescue of Post-Dural Puncture Headache After Combined Spinal-Epidural Anesthesia: A Case Report

Post-dural puncture headache (PDPH) is a common neuraxial anesthesia complication, often poorly managed conservatively. We report successful bilateral transnasal sphenopalatine ganglion block (SPGB) in a 52-year-old obese hypertensive woman (ASA II) who developed severe PDPH (pain 8/10) after accidental dural puncture during hysterectomy anesthesia. After 12 hours of failed conservative therapy, SPGB with 4% lidocaine reduced pain from 8/10 to 2/10 within 10 minutes, with complete resolution by 8 hours and sustained relief over 24 hours, no adverse effects. This case demonstrates transnasal SPGB as a rapid, effective, safe bedside alternative to epidural blood patch for PDPH.