Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients

Siegler, Benedikt Hermann; dos Santos Pereira, Rui Pedro; Keßler, Jens; Wallwiener, Stephanie; Wallwiener, Markus; Larmann, Jan; Picardi, Susanne; Carr, Richard; Weigand, Markus Alexander; Oehler, Beatrice

doi:10.3390/biomedicines11123296

Open AccessArticle

Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients

by

Benedikt Hermann Siegler

^1,*,

Rui Pedro dos Santos Pereira

¹,

Jens Keßler

¹,

Stephanie Wallwiener

^2,†,

Markus Wallwiener

^2,‡,

Jan Larmann

¹,

Susanne Picardi

¹,

Richard Carr

³

,

Markus Alexander Weigand

¹ and

Beatrice Oehler

¹

Department of Anesthesiology, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 420, D-69120 Heidelberg, Germany

²

Department of General Gynecology and Obstetrics with Polyclinic, Women’s Hospital, Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 440, D-69120 Heidelberg, Germany

³

Department of Anesthesiology, Medical Faculty Heidelberg, Universitaetsmedizin Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-17, D-68167 Mannheim, Germany

^*

Author to whom correspondence should be addressed.

^†

Current address: Center of Fetal Surgery, Department of Obstetrics and Prenatal Medicine, Halle University Hospital, Martin Luther University of Halle-Wittenberg, Ernst-Grube-Straße 40, D-06120 Halle (Saale), Germany.

^‡

Current address: Department of Gynaecology, Halle University Hospital, Martin Luther University of Halle-Wittenberg, Ernst-Grube-Straße 40, D-06120 Halle (Saale), Germany.

Biomedicines 2023, 11(12), 3296; https://doi.org/10.3390/biomedicines11123296

Submission received: 16 October 2023 / Revised: 17 November 2023 / Accepted: 8 December 2023 / Published: 13 December 2023

(This article belongs to the Special Issue Recent Advances in Craniofacial Pain and Headaches)

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Abstract

(1) Background: Postdural puncture headache (PDPH) remains a serious complication in obstetric patients. While the epidural blood patch represents the current gold standard in therapy, a growing number of alternative measures are thought to be beneficial for clinical management. The purpose of this study was to retrospectively analyze the efficacy of intranasal lidocaine administration to treat PDPH in obstetrics at our university hospital; (2) Methods: A retrospective analysis of the medical records of patients with PDPH has been performed focusing on the techniques of administration, dosing, treatment duration, impact on pain intensity as well as side effects of intranasal lidocaine; (3) Results: During the study period, 5610 obstetric patients received neuraxial anesthesia, of whom 43 (0.77%) developed PDPH. About one third of the patients with PDPH after spinal anesthesia (n = 8), epidural anesthesia (n = 5) or both (n = 2) were treated with intranasal lidocaine. Lidocaine was administered either via gauze compresses (GC, n = 4), a mucosal atomization device (MAD, n = 8) or with a second-line mucosal atomization device due to low gauze compress efficacy (n = 3). All patients treated with lidocaine refused the epidural blood patch. Nebulization of lidocaine resulted in a significant reduction in pain intensity after the first dose (p = 0.008). No relevant side effects developed except sporadic temporal pharyngeal numbness. The utilization of the mucosal atomization device averted the necessity for an epidural blood patch, whether employed as the primary or secondary approach; (4) Conclusions: Our data imply that the mucosal atomization device enhances the efficacy of intranasal lidocaine administration in obstetric patients suffering from PDPH.

Keywords: local anesthetics; topical treatment; midwifery; pain; epidural anesthesia; accidental dural puncture; sphenopalatine ganglion

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MDPI and ACS Style

Siegler, B.H.; dos Santos Pereira, R.P.; Keßler, J.; Wallwiener, S.; Wallwiener, M.; Larmann, J.; Picardi, S.; Carr, R.; Weigand, M.A.; Oehler, B. Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients. Biomedicines 2023, 11, 3296. https://doi.org/10.3390/biomedicines11123296

AMA Style

Siegler BH, dos Santos Pereira RP, Keßler J, Wallwiener S, Wallwiener M, Larmann J, Picardi S, Carr R, Weigand MA, Oehler B. Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients. Biomedicines. 2023; 11(12):3296. https://doi.org/10.3390/biomedicines11123296

Chicago/Turabian Style

Siegler, Benedikt Hermann, Rui Pedro dos Santos Pereira, Jens Keßler, Stephanie Wallwiener, Markus Wallwiener, Jan Larmann, Susanne Picardi, Richard Carr, Markus Alexander Weigand, and Beatrice Oehler. 2023. "Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients" Biomedicines 11, no. 12: 3296. https://doi.org/10.3390/biomedicines11123296

APA Style

Siegler, B. H., dos Santos Pereira, R. P., Keßler, J., Wallwiener, S., Wallwiener, M., Larmann, J., Picardi, S., Carr, R., Weigand, M. A., & Oehler, B. (2023). Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients. Biomedicines, 11(12), 3296. https://doi.org/10.3390/biomedicines11123296

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Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients

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