Modification of a Clinical Practice Guideline for the Treatment of Post-Dural Puncture Headaches to Include Sphenopalatine Ganglion Nerve Block

Postdural puncture headache (PDPH) is a relatively common complication of neuraxial anesthesia, with an occurrence rate as high as 50% following inadvertent dural puncture (Kwak, 2017). Due to the disabling nature of these headaches, interventions are focused at bringing relief to those suffering from this complication. While epidural blood patches are highly effective at treating PDPH and are considered the gold standard, they are not risk-free. A less-invasive alternative to the epidural blood patch is emerging as an effective intervention for treating PDPH. There is now growing evidence and emerging consensus opinion among anesthesia experts that SPGNBs are useful as a treatment of PDPH before attempting the epidural blood patch. The purpose of this Doctor of Nursing Practice (DNP) project is to modify a current nationally published clinical practice guideline (CPG) for the treatment of PDPH to include the early consideration for SPGNB and to further adapt the CPG for local implementation. The question this project addressed is whether the modified CPG would be appraised, using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) to be of higher quality than the original CPG. The theoretical framework guiding this project was Lewin’s Change Theory. The modified CPG was presented to stakeholders at a local healthcare facility in metro Phoenix, Arizona for consideration of implementation. This DNP quality improvement project intended to translate emerging evidence into a local practice for the benefit of improving consistency of evidence-based care