The versatility of the transnasal sphenopalatine ganglion block.

Abstract

Dear Editor, We read with great interest the article by Ferjani et al.1 on how a patient’s headache from a postoperative spinal dural tear was successfully relieved with a bilateral transnasal sphenopalatine ganglion block. This is a simple and valuable technique that was discovered in 1908, but few anesthesiology or pain physicians are familiar with the block and its versatility. Intranasal devices for the administration of the transnasal sphenopalatine ganglion block are available but are expensive and might not be readily available at all institutions. To safely and inexpensively perform the transnasal sphenopalatine ganglion block to treat headaches and also extend the treatment to other types of pain, we have created our own device from supplies that are readily accessible in most medical facilities. For our transnasal sphenopalatine ganglion block applicator, we attached a 3-mL syringe (filled with 4% lidocaine hydrochloride solution) to one side of intravenous extension tubing with a stopcock, and we attached a hollow cotton swab dipped into 5% lidocaine ointment to the other side of the tubing. The patients position themselves supine with neck extension and hemodynamic monitoring. The applicator is gently advanced perpendicular to the patient’s nostril until the tip reaches the back of the nasal pharynx and gentle resistance is met. Lidocaine 4% is administered slowly under low pressure through the cotton-tipped applicator until the medication is felt in the back of the throat. A second applicator is then inserted into the opposite nostril, and the medication is administered as before. Symptoms are evaluated 15 minutes after insertion. If the symptoms are not sufficiently relieved, this procedure is repeated up to 2 more times. In our experience, this transnasal sphenopalatine ganglion block has successfully relieved the pain amenable to sphenopalatine ganglion blockade; importantly, this approach has not had a technical failure.