Sphenopalatine Ganglion Blockade Research Articles

Midterm Clinical Outcomes of Repetitive Transnasal Sphenopalatine Ganglion Blockade in Chronic Migraine

Aim: Chronic migraine affects quality of life negatively, causing high rates of disabilities. There is a requirement for specific prophylactic treatment options in chronic migraine patients. We aimed to evaluate effects of repetitive transnasal sphenopalatine ganglion blockade (SPG) on headache days, severity and duration of attacks, drug abuse, conversion to episodic migraine, and responses to chronic migraine treatment.
 Materials and Methods: Diagnosed with chronic migraine for at least six months, patients referred to the algology clinic and unresponsive to prophylactic treatments or not tolerating prophylactic treatments were evaluated in the study with a retrospective design. Patients undergoing four-session bilateral transnasal SPG blockade per week were included. SPG was performed with 0.5 cc 0.5% bupivacaine-impregnated swab sticks for 30 minutes.
 Results: In first, third, sixth, and ninth month follow-ups of 40 patients included, a statistically significant improvement was found in number of headache days and parameters of attack severity and frequency, compared to baseline values (p

Sphenopalatine ganglion block with lidocaine versus bupivacaine for optimizing intraoperative bleeding and surgical field visibility during endoscopic septoplasty: a randomized double-blind controlled trial

Background & objective: The benefits of sphenopalatine ganglion (SPG) block during endoscopic septoplasty are yet unclear due to a lack of adequate data. We investigated the efficacy of SPG block (SPGB) with lidocaine versus bupivacaine for minimizing intraoperative bleeding and providing a bloodless surgical field in patients having endoscopic septoplasty under general anesthesia. Methodology: In this double-blind, randomized controlled trial, 60 patients with ASA I and II were scheduled for endoscopic septoplasty. Following standard general anesthesia, patients were randomly assigned to one of three groups. Group C (n = 20): SPGB was performed using normal saline in the control group; Group L (n = 20); patients received SPGB with 2% lidocaine, and Group B (n = 20); patients received SPGB with 0.5% bupivacaine. Intraoperative blood loss, surgical field quality, postoperative pain-free duration, postoperative analgesic requirements, and the patient satisfaction were recorded. The collected data were verified, coded by the researcher, and analyzed using the Statistical Package for Social Sciences (IBM-SPSS/PC/VER 21). Statistical analysis was done with the Shapiro-Wilk test, one-way ANOVA test and two-way repeated measure ANOVA test as required. The Kaplan–Meier curve was plotted to explore the differences in the post-operative pain-free durations among the studied groups using the log-rank test. A p-value less than 0.05 was considered significant. Results: The intraoperative blood loss and surgical field grading were lower in the groups treated with lidocaine (44.9 ± 3.7 ml, P < 0.001) or bupivacaine (41.4 ± 2.9 ml, P < 0.001) in comparison to the control group (89.95 ± 7.8 ml). There was no difference between the two groups. Postoperative meperidine requirement in 24 h was higher in the control group (36.25 ± 2.9 mg) than the lidocaine group (18.75 ± 2.5 mg; P < 0.001) and the bupivacaine group (16.25 ± 2.7 mg; P < 0.001). Conclusion: Sphenopalatine ganglion blockade with bupivacaine or lidocaine decreased intraoperative blood loss and improved surgical field visibility compared to placebo during endoscopic septoplasty under general anesthesia. There were statistically no significant differences in sphenopalatine ganglion blocks with either lidocaine or bupivacaine. Abbreviations: SPG- Sphenopalatine Ganglion; SPGB- Sphenopalatine Ganglion Block; VAS- Visual Analog Scale Keywords: Bupivacaine; Endoscopic Septoplasty; Lidocaine; Postoperative Analgesia; Sphenopalatine Ganglion Block Citation: Ghazaly HF, Khalefa MM, Sedeek MA, Hasanen MK. Sphenopalatine ganglion block with lidocaine versus bupivacaine for optimizing intraoperative bleeding and surgical field visibility during endoscopic septoplasty: a randomized double-blind controlled trial. Anaesth. pain intensive care 2024;28(1):92-99; DOI: 10.35975/apic.v28i1.2393 Received: August 29, 2023; Reviewed: December 29, 2023; Accepted: December 31, 2023

The effect of transnasal sphenopalatine ganglion blockade on pain, functional capacity, sleep, and depression in patients with fibromyalgia.

The Sphenopalatine Ganglion (SPG) is the target of interventional procedures in musculoskeletal pain, especially headaches, due to its role in the autonomic nervous system. Our study aimed to investigate the effect of transnasal sphenopalatine ganglion blockade (SPGB) on pain, functional capacity, sleep, and depression in fibromyalgia patients. The hospital records of fibromyalgia patients who applied to the Algology outpatient clinic between January and May 2021, unresponsive to standard medical treatments, and underwent six sessions of bilateral transnasal SPGB at 10-day intervals were analyzed retrospectively. Numerical Rating Scale (NRS), functional capacity Fibromyalgia Impact Questionnaire (FIQ), sleep status Pittsburgh Sleep Quality Index (PSQI), and depression severity Beck Depression Inventory (BDI) data were collected during the treatment process. The mean NRS score of the patients before the treatment was 8.1852±1.71053, compared with 6.2593±2.29703 after the treatment. The mean FIQ score of the patients before the treatment was 73.0359±13.55302, compared with 54.2507±16.1906 after the treatment. After the treatment, the pain score, functional capacity, sleep quality, and depression of the patients were statistically significantly different than pretreatment (p<0.001). SPGB has been found to positively affect pain, functional capacity, sleep disorders, and depression in patients with fibromyalgia.

Infrazygomatic Versus Intranasal Injection Approaches for Sphenopalatine Ganglion Blockade Effect on The Surgical Field in Functional Endoscopic Sinus Surgeries

Infrazygomatic Versus Intranasal Injection Approaches for Sphenopalatine Ganglion Blockade Effect on The Surgical Field in Functional Endoscopic Sinus Surgeries

Postoperative effects of bilateral sphenopalatine ganglion blockade in septorhinoplasty operations; double-blind randomized clinical trial

ObjectiveWe aimed to investigate the effect of bilateral sphenopalatine ganglion blockade (SPGB) on the main postoperative complications in septorhinoplasty operations. MethodsIn this randomized, controlled, prospective study, 80 cases planned for Septorhinoplasty operations under general anesthesia were included in the study. The cases were divided into two groups; SPGB was performed with 2 mL of 0.25% bupivacaine bilaterally 15 min before the end of the operation in the SPGB group (Group S, n = 40). In the control group (Group C, n = 40), 2 mL of 0.9% NaCl solution was applied into both SPG areas. In the recovery unit after the operation; the pain and analgesic needs of the patients at 0, 2, 6 and 24 h were evaluated. ResultsThere was no statistically significant difference between the groups in terms of hemodynamic parameters (ASA, MBP, HR) (p > 0.05) All VAS values were statistically lower in Group S than in Group C (p < 0.05). In Group S, the need for analgesic medication was found in 5 cases between 0–2 h, whereas in Group C, this rate was found in 17 cases, and it was statistically significant (p < 0.05). ConclusionBilateral SPGB application was determined to provide better analgesia in the early postoperative period compared to the control group, it was concluded that further studies are needed to say that there are significant effects on laryngospasm and nausea-vomiting. Level of evidence2, degree of recommendation B.

Comparison of outcomes of transnasal sphenopalatine ganglion and ultrasound-guided proximal greater occipital nerve blockades in chronic migraine

Background &amp; Objective: A need exists for prophylactic treatment options for chronic migraine. Our aim was to evaluate and compare the effect of greater occipital nerve (GON) and transnasal sphenopalatine ganglion (SPG) blockade on headache days, responder rate, attack severity, attack frequency, and medication overuse in patients with chronic migraine. Methods: This was a retrospective study. The GON blockade was performed at the proximal level under ultrasound guidance with 1.5 cc 0.5% bupivacaine, and the SPG blockade was performed transnasally with 0.5 cc 0.5% bupivacaine applied for 30 minutes with swab sticks. Patients who completed bilateral blocks applied in four weekly sessions were included in the analysis. Results: Seventy patients (GON=37, SPG=33) were included in the study. Both groups showed a significant improvement in the number of days with headache, severity of attacks, and frequency of attacks at the first- and third-month follow-up visits compared to the baseline (p&lt;0.001). Responder rates were similar at the first- and third-month follow-up visits (r= 3.707, p=0.054; r=0.071, p=0.790, respectively). At the third-month follow-up, the prevalence of medication overuse decreased from 78% to 13% in the GON group and from 57% to 9% in the SPG group, and these differences were statistically significant (p&lt;0.001 for both groups). No significant difference was noted in efficacy between the treatment groups (p=0.714). No significant adverse effects occurred in either group. Conclusion: Both proximal GON blockade and minimally invasive SPG blockade are effective and safe options for prophylaxis in patients with chronic migraine.

The versatility of the transnasal sphenopalatine ganglion block.

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.

Comparison of the Efficacy of Epidural Blood Patch and Transnasal Sphenopalatine Ganglion Block in the Treatment of Postspinal Puncture Headache

Aim: Postspinal puncture headache (PDPH) affects postoperative recovery and patients' quality of life after surgery. PDPH is the most common complication of spinal anaesthesia that affects patients' well-being the most. The epidural blood patch (EBP) is the gold standard for interventional treatment of PDPH. Sphenopalatine ganglion block (SPGB), a new noninvasive method for treating PDPH, has come to the forefront. SPGB is noninvasive and very easy to perform compared with EBP. This study aims to compare the efficacy of the two interventional methods in treating PDPH. Material and Method: Between January 1, 2018, and February 1, 2023, 30 cases diagnosed with PDPH underwent EBP and 28 SPGB. Case demographics, type of surgery performed, whether complications occurred after the procedure, and the amount of acetaminophen taken within 24 hours were recorded in mg. The VAS scores were recorded 8 times, in the first half hour before and after surgery, and, 1, 2, 4, 6, 12 and 24 hours after the surgery. Results: There was no statistically significant difference between the distributions of sex, type of surgery, and amount of acetaminophen taken after surgery by groups (p values respectively p= 0.245, p=0.994, p=0.131 ). There was a statistically significant difference between the distributions of 4th-hour values VAS by group (p=0.008). There is a statistically significant difference between the groups' distributions of the values of the 6th-hour VAS (p=0.016). VAS scores were lower in the epidural blood patch group. There was no difference between the VAS scores in the blood patch and block group in all other measurement periods. Nevertheless, comparing the time variables of the groups, the main effect of time has a statistically significant impact on the VAS (p &lt; 0.001). There was a significant difference in the sphenopalatine ganglion block and epidural blood patch groups when the pre-surgery VAS value was compared with all post-surgery periods (p &lt; 0.001, p &lt; 0.001). Conclusion: The epidural blood patch is the gold standard in treating postspinal headaches. However, it is a difficult procedure to perform since it is an invasive procedure. Sphenopalatine ganglion blockade is a treatment modality with very close efficacy to epidural blood patches in treating postspinal headaches. It can be used as an alternative treatment method in cases that do not accept treatment with the epidural blood patch. As postspinal headache mostly occurs in obstetrics patients, it can be safely used to protect a newborn mother and the baby from the side effects of drugs that pass into the breast milk.

Effectiveness of sphenopalatine ganglion block for V1 trigeminal neuralgia secondary to herpes zoster. case report

Introduction: Postherpetic V1 branch trigeminal neuralgia (TN) is a different neuralgia of the maxillary and mandibular divisions. This is usually refractory to conventional management since the involvement of the ophthalmic division can produce obvious autonomic symptoms. Few cases have been described, and conventional therapy is usually ineffective. Multimodal analgesic approaches are required in which regional anesthesia is considered an option, in order to optimize the response and improve the patient's quality of life. Methodology: A clinical case of a previously healthy 43-year-old female with a history of facial Herpes Zoster is reported. She presents TN of the left unilateral ophthalmic division for six months of evolution. The characteristic pain is accompanied by autonomic manifestations, refractory to pharmacological treatment. A sphenopalatine ganglion (SPG) block was performed in the pterygopalatine fossa with an infracygomatic approach. The evolution of pain was recorded on the Numerical Visual Analog Scale (VAS) and the quality of life was reported by the Headache Impact Test (HIT-6) scale on days 1, 15, 30, and 90 after the procedure. It was correlated with what was reported in the literature, finding only three cases related to autonomic trigeminal neuralgia (TN), which were treated with radiofrequency. The strongest evidence lies in the use of sphenopalatine ganglion block, radiofrequency ablation, and neurostimulation for cluster headaches. Results: A decrease in pain was reported on the VAS scale from 10/10 to 0/10 after the procedure, which was maintained during the first month without presenting autonomic symptoms. In the third month, VAS 2/10 is recorded, which is accompanied by tears. According to the HIT-6 scale, there was an improvement in quality of life from 69 points (very severe impact) to 36 points (little or no impact). Discussion: In recent studies, the connection of the ophthalmic nerve with the SPG has been found, in such a way that it is a possible explanation of why the SPG block is effective for pain relief in the ophthalmic nerve area in patients with TN. Conclusion: The present case of TN V1, with SPG blockade, showed analgesic efficacy and improvement in the quality of life reported by the patient. Further research with larger cohorts is required to standardize the procedure for such a diagnosis.

Bilateral Sphenopalatine Ganglion Block With Liposomal Bupivacaine Followed by Severe Hypertension: A Case Report

We reviewed a case of bilateral sphenopalatine ganglion (SPG) blockade with liposomal bupivacaine for sinus surgery. The case was complicated by severe postoperative hypertension refractory to antihypertensives and needing intensive care unit (ICU) admission. While SPG blockade has been used to treat headaches and provide perioperative analgesia, this complication and a possible mechanism have not been described. We discuss how local anesthetic spread beyond the SPG may have caused prolonged parasympathetic blockade and hypertension. Before approved indications are established, we recommend avoiding the use of liposomal bupivacaine in off-label settings when the function of bilateral autonomic structures could be affected.

The effectiveness of sphenopalatine ganglion blockade in chronic migraine resistant to medical treatment

Objective: To assess the effectiveness of sphenopalatine ganglion blockade (SPGB) as an alternative treatment for patients with chronic migraine resistant to medical treatment. Methods: In total, 23 patients with chronic migraine resistant to medical treatment underwent 4 sessions of bilateral transnasal SPGB bi-weekly, and the monthly number of headache days, duration, and numerical rating scale (NRS) response results were recorded. Results: Compared with before SPGB, the frequency of migraine attacks per month (23.66 ± 9.8 vs. 10.5 ± 11.9 days), duration of headaches (31.3 ± 16.8 vs. 18.4 ± 9.8 h), and NRS score (9 ± 0.99 vs. 5.1 ± 2.1) all improved significantly (p &lt; 0.05) eight weeks after intervention. Conclusion: Transnasal SPGB is an alternative to conventional therapy because it benefits patients with chronic migraine resistant to medical treatment, is easy to administer, and has few side effects.

Transnasal Sphenopalatine Ganglion Block for the Preventive Treatment of Chronic Daily Headache in Adolescents.

Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims to evaluate the SPG block for the preventive treatment of chronic daily headache (CDH) in adolescents. We prospectively evaluated 17 adolescents (14 females, 14 ± 1 year) with CDH not responding to cognitive behavioral therapy (CBT), physiotherapy, and standard medications. Each patient received 10 SPG blocks (two blocks/week) using the Tx360® device. At the end of treatment, 10 patients (59%) reported a Patient’s Global Impression of Change (PGIC) score ≥ 67%, and 3 months after the end of treatment, nine patients (53%) sustained a PGIC ≥ 67%. There was also a statistically significant reduction in the depression subscale of the Revised Children’s Anxiety and Depression Scale (RCADS) at the end of treatment and 3 months post-treatment compared with baseline. The procedure was well tolerated with no adverse effects. In our study, the use of repeat SPG blockade was associated with sustained benefits on the PGIC and the depression subscale of the RCADS when used as preventive headache treatment in adolescents with refractory CDH.

Peripheral Nerve Blockade and Botox Treatment in Chronic Migraine: A Comparative Study

Migraine is the most commonly encountered disabling headache. Chronic migraine significantly affects the quality of life and reduces the ability to attend work and social events, and consequently becomes an increasing economic burden.In recent years, peripheral nerve block with botulinum toxin A (botox) and local analgesics has been included in alternative treatment regimens.In cases of chronic migraine, botox is injected into the facial area, maxillary and mandibular nerve, and the head and neck muscles.Recent methods such as great occipital nerve (GON), and lesser occipital nerve, supra orbital nerve (SON), sphenopalatine ganglion blockade and trigeminal ganglion blockade have been applied using local analgesics. GON and SON blockade are the most frequently used of these methods. Studies related to these methods have shown a decrease in the frequency and severity of migraine pain.The results of this study showed that both GON and SON blockade and long-term application of BTX-A treatment were highly effective in the treatment of chronic migraine and both treatment methods had a similar level of effectiveness.That the follow-up period of this study was longer than in previous research can be considered a strong aspect of the study.

Sphenopalatine Ganglion Nerve Block for the Treatment of Migraine Headaches in the Pediatric Population

BACKGROUND: Persistent headaches and migraines are common in pediatrics with various treatment options. The sphenopalatine ganglion (SPG) has been identified as communicating with the parasympathetic autonomic nervous system and pain receptors. In adults, SPG block is an established treatment but there is no published literature in pediatrics. OBJECTIVES: The purpose of this study is to analyze the SPG block in pediatrics. STUDY DESIGN: Retrospective, single-center study. SETTING: This study was conducted at Phoenix Children’s Hospital in Phoenix, Arizona. METHODS: A comprehensive review of patient charts from 2015–2018 of all pediatric SPG blockades performed by interventional radiology were included in the analysis. Utilizing fluoroscopic guidance, a SphenoCath was inserted into each nostril and after confirming position, and 4% lidocaine injected. Pre- and postprocedural pain was assessed using the Visual Analog Scale (VAS). Immediate and acute complications were documented. RESULTS: A total of 489 SPG blocks were performed in patients between ages 6 and 26 years who were diagnosed with migraine or status migrainosus. One hundred percent technical success was achieved with mean reduction of pain scores of 2.4, which was statistically significant (P &lt; 0.0001). There were no immediate or acute complications. LIMITATIONS: Results of this study were based on retrospective study. The use of VAS may be subjective, and the need of a prospective study may be necessary. CONCLUSIONS: With 100% technical success, statistically significant pain reduction, and no complications, we support SPG block in the pediatric population as a simple, efficacious, and safe treatment option for refractory headaches. It is routinely performed in less than 10 minutes and commonly negates the need for inpatient headache pain management. Given its minimal invasivity, we support the use of SPG blockade as a therapeutic treatment in refractory pediatric migraines as it reduces the need for intravenous medications, prolonged pain control, or hospital admission. KEY WORDS: Chronic, migraine, minimally invasive, nerve block, pediatric, sphenopalatine

Topical intranasal lidocaine is not a sphenopalatine ganglion block

There is renewed interest in the central role of the sphenopalatine ganglion (SPG) in cerebrovascular autonomic physiology and the pathophysiology of different primary and secondary headache disorders. There are diverse...

Sphenopalatine Ganglion Stimulation for Chronic Headache Syndromes.

Neuropathic facial pain is notoriously difficult to treat, regardless of its origin and duration. Since the first reported sphenopalatine ganglion blockade by Sluder in 1908, this ganglion has assumed an important role among the structures targeted for the treatment of facial pain. Recent years have witnessed the rise of neuromodulation over ablative procedures, including the development of an implantable stimulation device specially designed for use in the pterygopalatine fossa. Sphenopalatine ganglion stimulation has been demonstrated as effective and safe for refractory cluster headache, today the major indication for this therapy, but increasing evidence shows that the effect on the autonomic system and cerebral circulation could justify an even wider use of sphenopalatine ganglion stimulation for other chronic headache syndromes and vascular diseases.

Acute Ocular Effects of Sphenopalatine Ganglion Nerve Block.

Aim and objectiveThe goal of this study was to measure acute ocular effects in patients undergoing routine sphenopalatine ganglion (SPG) nerve block for headache. Projections from the SPG influence blood flow to the eye which may influence intraocular pressure (IOP). There are limited animal and human studies investigating the relationship between the SPG and its effect on the eye.Materials and methodsThis was a single-site, investigator-initiated, single-visit, prospective study. Participants were aged 18–85 years old who had consented to SPG nerve block for headache. The primary outcome measures were change in near visual acuity (NVA) and IOP pre-procedure to immediately post-procedure. Additional data collected included pupil diameter and presence of any ocular or visual complaints.ResultsA total of 13 patients were enrolled in the study. Average pre-procedure IOP was 14.2 mm Hg [standard deviation (SD) 3.8] in the right eye and 13.7 mm Hg (SD 3.2) in the left eye. Average post-procedure IOP was 14.8 mm Hg (SD 3.8) in the right eye and 14.2 mm Hg (SD 2.9) in the left eye. Neither the right nor left eye experienced a statistically significant change in IOP after SPG block. There were no statistically significant changes in average NVA or pupil diameter in either eye. There were no adverse events.Conclusion and clinical significanceThis pilot study suggests no significant acute changes in IOP or other ocular parameters after SPG block for headache disorders and supports the fact that the procedure is safe as it relates to ocular health. The ocular effects of SPG blockade merit further study in a larger cohort of patients.How to cite this articleSiegel DT, Ertel MK, Patnaik JL, et al. Acute Ocular Effects of Sphenopalatine Ganglion Nerve Block. J Curr Glaucoma Pract 2020;14(2):57–60.

Sphenopalatine Ganglion Block and Radiofrequency Ablation: Technical Notes and Efficacy.

Background: Sphenopalatine ganglion (SPG) blockade or lesioning can offer significant pain relief for cluster headaches (CHs) and a variety of other pain syndromes involving the head and face. Methods: We reviewed the literature on the efficacy of SPG block and radiofrequency ablation (RFA) using PubMed and Google Scholar. Results: The infrazygomatic technique can be used to directly access the SPG for injection of local anesthetic or lesioning using RFA. Important technical points to achieve these procedures are described. SPG blockade efficacy is supported by randomized controlled studies but SPG RFA is not. Conclusion: Targeting the SPG is a promising treatment option for refractory CHs. RFA and neuromodulation have the potential to offer long-term significant pain relief, but more randomized studies are needed to demonstrate their efficacy.

How We Do It: Sphenopalatine Ganglion Blockade for Migraine Treatment

Migraine is a common disorder with a range of available abortive and prophylactic treatments. Sphenopalatine ganglion blockade is an effective and safe option for treatment and prevention of migraine disorders. We present an instructional article for sphenopalatine ganglion blockade, including recommended patient selection, treatment procedure, and clinical follow up.

Transnasal sphenopalatine ganglion blockade for acute facial pain: a prospective randomized case-control study.

Long-term physical inactivity can cause the atrophy of skeletal muscle. The aim of this study is to explore the underlying mechanisms of physical inactivity-induced atrophy of skeletal muscle. 14 Sprague- Dawley (SD) male rats were divided into 2 groups including normal control (NC) and hindlimb suspension (HS) groups. After two weeks of HS stimulation, the ratio between skeletal muscle weight and body weight, and cross-sectional area (CSA) of skeletal muscle fibers, were measured. Western blot was applied to evaluate the expression of proteins associated with atrophy and autophagy. The transmission electron microscope was used to observe the ultra-microstructure and the mitochondrial quality of skeletal muscle. The rats subjected to 2-week HS treatment presented an evident atrophy of the skeletal muscle with a significantly reduced ratio between skeletal muscle weight and body weight, and smaller cross-sectional area (CSA) of skeletal muscle fibers when compared with control rats. Meanwhile, HS stimulation resulted in the damage of mitochondria, the increased expression of MuRF1 and Atrogin-1/MAFbx, and enhanced apoptosis, as well as dysfunctional autophagy in skeletal muscle. HS-induced skeletal muscle atrophy involves the activation of AMPK/FoxO3 signal pathway, evidenced as AMPK phosphorylation, FoxO3 activation, and Atrogin-1 and MuRF1 up-regulation. FoxO3-mediated autophagy plays an important regulatory role in HS-induced skeletal muscle atrophy.