Transnasal Sphenopalatine Ganglion Block Research Articles

Avoiding Invasive Measures: Sphenopalatine Ganglion Block as a Substitute for Epidural Blood Patch in Post-dural Puncture Headache: A Case Report

Introduction: Post-dural puncture headache (PDPH) is a well-known consequence of neuraxial anesthesia that can impede patient recovery and delay early discharge. Traditional remedies include hydration and the administration of simple analgesics for symptom relief. When symptoms persist despite conservative interventions, an epidural blood patch (EBP) is typically recommended. However, this invasive procedure carries risks and complications. Our case report aims to explore a potential alternative treatment for PDPH. Case Presentation: We present the case of a 22-year-old female who experienced PDPH following spinal anesthesia. Despite initial attempts at conservative management, her symptoms persisted. She then opted for a trans-nasal sphenopalatine ganglion (SPG) block, which resulted in remarkable pain relief and eliminated the need for an EBP. Conclusions: The SPG block emerges as a minimally invasive option for treating PDPH. Multiple studies have demonstrated that patients undergoing SPG block therapy did not require EBP.

Case Report on the Efficacy of Transnasal Sphenopalatine Ganglion Block for the Treatment of Severe Post-Dural Puncture Headache after Failed Subarachnoid Block

Case Report on the Efficacy of Transnasal Sphenopalatine Ganglion Block for the Treatment of Severe Post-Dural Puncture Headache after Failed Subarachnoid Block

Efficacy of Sphenopalatine Block in Patients with Post-Dural Puncture Headache after Cesarean Section

Our study emphasised the efficacy of sphenopalatine ganglion block (SPGB) in patients with post-dural puncture headache (PDPH) after cesarean section. In this clinical experiment, the effectiveness of the SPGB in treating PDPH in pregnant women was examined. 40 individuals with PDPH were randomly divided into two equal groups for a prospective randomised clinical trial. The group receiving paracetamol (PG) for one day, the patients take 1 gram of paracetamol intravenously three times daily. Rescue analgesia in intravenous ketorolac is administered if sufficient pain relief cannot be found. Block group (SPGBG): Each nostril of the patients received a 3 ml dose of a lignocaine and dexamethasone mixture during bilateral SPGB. Recordings were made of the heart rate, arterial pressure, and mean pain score. Additionally noted were the initiation and end of the analgesic effect, any adverse effects, the amount of ketorolac used, patient satisfaction, and whether the patient stayed in the hospital for an EBP (epidural blood patch) or was discharged after 24 hours. The block group's pain perception (measured by a numeric rating scale [NRS]) was usually less during the research, with only a significant difference until the first two hours following the block when analgesia began more quickly and lasted longer. The hospital stay of the block group for EBP was substantially shorter and had higher patient satisfaction than the control group, which also had a much lower overall dose of the rescue analgesic in milligrams. Conclusions: Trans-nasal SPGB is a non-invasive, safe, simple, and effective treatment for post-dural puncture headache (PDPH) with a low complication rate.

Effectiveness of Transnasal Sphenopalatine Ganglion Block for Persistent Hiccups Treatment

Effectiveness of Transnasal Sphenopalatine Ganglion Block for Persistent Hiccups Treatment

Optimizing techniques for in-office endoscopic transnasal sphenopalatine ganglion block injections

Otolaryngologists play a central role in diagnosing and treating facial pain syndromes and headache disorders. Although sphenopalatine ganglion block is a recognized treatment option, literature on transnasal injection techniques is limited. This study's objective is to refine anatomic landmarks and optimize a technique for in-office transnasal sphenopalatine ganglion blocks. Eight cadaveric head specimens were dissected to record sixteen measurements of critical anatomic landmarks and surgical instruments for sphenopalatine ganglion block. On average, the sphenopalatine foramen center was 5.94 mm (±1.65 mm) superior to the inferior border of the middle turbinate's basal lamella attachment to the lateral nasal wall. We describe the reliability of using a 20G spinal needle bent at 70-degrees to perform a transnasal injection technique for sphenopalatine ganglion block. The inferior border of the middle turbinate basal lamella attachment to the lateral nasal wall may be used as an intranasal landmark in transnasal injection of the sphenopalatine ganglion. Further testing in the clinical setting is required to assess efficacy.

Sphenopalatine Ganglion Block With Lidocaine Drops Relieves Lower Extremity Complex Regional Pain Syndrome: A Case Report

BACKGROUND: Lower extremity complex regional pain syndrome (CRPS) is a debilitating, neuropathic pain disorder that may develop into a refractory, chronic condition, which currently has no gold-standard treatment. We would like to share the first report of a transnasal sphenopalatine ganglion block with lidocaine that effectively relieved the pain of a patient suffering from lower extremity CRPS. CASE REPORT: A 48-year-old man with CRPS suffered from pain that was resistant to analgesic medications, spinal blocks, and a spinal cord stimulator. A sphenopalatine ganglion block was administered to the patient via long, hollow cotton-tip applicators with lidocaine drops. After just one block, for the first time in 10 years, he was 100% pain free for 5 days. CONCLUSIONS: This case report demonstrates that the lidocaine sphenopalatine ganglion block could be a simple, safe, inexpensive, and noninvasive treatment option for those affected by lower extremity CRPS. KEY WORDS: Sphenopalatine ganglion block, lidocaine, chronic pain, complex regional pain syndrome

Sphenopalatine Ganglion Block for Headache Treatment After an Incidental Durotomy: A Case Report.

Incidental durotomy is the most common intraoperative complication of spine surgeries. Our main goal is to report a case of a postoperative postdural puncture headache following an incidental durotomy successfully managed with a sphenopalatine ganglion block. A 75-year-old woman, American Society of Anesthesiologists physical status II, proposed for a lumbar interbody fusion. During surgery, an incidental durotomy with cerebrospinal fluid leak occurred, being repaired with muscle and DuraSeal® Dural Sealant System. In the recovery room, 1 hour after the end of the surgery, the patient developed a severe headache associated with nausea and photophobia. A bilateral transnasal sphenopalatine ganglion block with 0.75% ropivacaine was performed. Immediate pain relief was verified. The patient reported only mild headaches on the first postoperative day, feeling progressively better until discharge. The sphenopalatine ganglion block may be an effective alternative treatment for postdural puncture headache following an incidental durotomy during neurosurgeries. Sphenopalatine ganglion block may be a safe, lowrisk alternative in the treatment of postdural puncture headache after an incidental durotomy that can be used in the immediate postoperative period to enable early recovery and return to day-to-day activities, which will hopefully lead to better surgical outcomes and patient satisfaction.

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 < 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 < 0.001, p < 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.

Efficacy and efficiency of sphenopalatine ganglion block for management of post-dural puncture headache in obstetric patients: a randomized clinical trial

BackgroundThis clinical trial aimed to study the efficacy and efficiency of sphenopalatine ganglion block (SPGB) for the management of post-dural puncture headache (PDPH) in obstetric patients. A prospective randomized clinical trial was carried out on 40 patients with PDPH divided randomly into two equal groups. Paracetamol group (PG): The patients received 1 g of paracetamol three times per day intravenously for 1 day. If adequate pain relief was not achieved, rescue analgesia in the form of intravenous ketorolac was given. Block group (SPGBG): The patients received bilateral SPGB using 3 ml mixture of lignocaine with dexamethasone in each nostril. The pain score, heart rate, and mean arterial pressure were recorded. The onset of analgesia, duration of analgesia, adverse effects, total dose of ketorolac, patient satisfaction, and hospital stay for epidural blood patch (EBP) or hospital discharge after 24 h were also documented.ResultsThe pain perception (numeric rating scale [NRS]) in the block group was generally lower throughout the study showing only highly significant difference till the first 2 h after the block with more rapid onset and longer duration of analgesia. The total dose of rescue analgesic in mg was significantly lower in the block group and hospital stay for EBP was significantly less in the block group with higher patient satisfaction.ConclusionsPDPH can be treated effectively and rapidly with transnasal SPGB, which is a noninvasive, safe, and easy method with a low complication rate.Trial registrationClinicalTrials.gov, NCT04793490. Registered on March 11, 2021; https://clinicaltrials.gov/ct2/show/NCT04793490).

A Prospective Cross-sectional Study to Analyze the Effect of Transnasal Sphenopalatine Ganglion Block in Carcinoma Buccal Mucosa Patients

Introduction: Cancer pain is known to be one of the Most severe pain anyone in life and is the primary reason for discontinuation of treatment. Sphenopalatine ganglion block (SPGB) can be useful in alleviating pain of carcinoma buccal mucosa. The study aims to analyze the effect of transnasal SPGB in pain management of patients suffering from carcinoma buccal mucosa. Materials and Methods: It was a hospital-based study done on 150 patients with carcinoma buccal mucosa using a prospective cross-sectional study design. To do statistical analysis, paired t-test was used having SPSS software. Results: On visual analogue scale, intensity of pain was found to be notably reduced from 7.42±2.02 to 3.45±1.21 (P < 0.0001), after first sitting. Preprocedure and postprocedure morphine requirement were 90.24 ± 30.24 and 60.42 ± 0.93 mg/day (P > 0.05) At the conclusion of study, the results were found to be statistically significant. Conclusion: Transnasal SPGB is beneficial in improving patient compliance and reducing pain scores and morphine requirement in patients suffering from carcinoma buccal mucosa.

Transnasal sphenopalatine ganglion block for pain relief during panretinal photocoagulation laser for diabetic retinopathy: a pre and post interventional study

This study was performed to utilize transnasal Sphenopalatine Ganglion (SPG) block for pain reliving during panretinal photocoagulation (PRP) in diabetic patients with diabetic retinopathy. This pre and post interventional study was performed on 20 patients with proliferative diabetic retinopathy. The first PRP treatment session of all the patients is performed with no transnasal SPG block, but before holding the second session, all the patients underwent transnasal SPG block and pain levels during and after PRP were compared to each other. Before the transnasal SPG block, each nostril of all the cases was inspected for finding any obstruction in each PRP session. Transnasal SPG block was also performed in with 2% lidocaine. The mean age of the included cases was 52.84 ± 8.62 years old (from 36 to 72 years old). All the cases underwent two PRP lasers treatment sessions with the same characteristic (spot size, power and duration) for each patient. In the first and second PRP treatment sessions, the mean NRS scores were obtained immediately after the PRP laser (8.4 vs. 4.2), 15 min (8.2 vs. 4.2), 1 h (8.0 vs. 4.1), and 24 h (5.4 vs. 3.6) after the PRP respectively. The mean NRS scores significantly reduced during the second PRP treatment session compared to the first session (p < 0.001). Transnasal SPG block is a safe and effective strategy used for relieving pain caused by the PRP laser treatment in patients with diabetic retinopathy.

Persistent Coronavirus Disease 2019 Headache Relieved with Sphenopalatine Ganglion Block.

According to the World Health Organization, as of September 2021, there have been over 226.8 million people diagnosed with coronavirus disease 2019 and over 4.6 million deaths from this disease. Out of those who have survived the coronavirus disease 2019 infection, many individuals have symptoms that linger on. We would like to describe the first report of a patient with a 5-month history of a persistent coro- navirus disease 2019 headache, which was finally successfully aborted with a single transnasal sphenopalatine ganglion block. A female in her early 50s presented to our pain clinic after suffering from a new, debilitating headache that began with the coronavirus disease 2019 illness and persisted for 5 months. Every evening the patient would experience a severe headache located deep inside/behind the left eye that would be resistant to analgesic medications. After 1 transnasal sphenopalatine ganglion block, the patient's coronavirus disease 2019 headache was completely resolved.

Comparison of Temperature and Pain Changes between the Drip and Topical Methods of Administering the Transnasal Sphenopalatine Ganglion Block.

The objective of this study was to compare facial temperatures and the visual analogue scale (VAS) between the drip method and the topical method of transnasal sphenopalatine ganglion block (SPGB). The transnasal SPGB is administered to patients with facial or head and neck pain. In the transnasal approach, the drip and topical methods are frequently used. We compared facial temperatures and VAS after transnasal SPGB. Medical records of 74 patients who visited the pain clinic and underwent transnasal SPGB were retrospectively reviewed. A total of 156 transnasal SPGB were performed. The patients were divided into the drip-method and topical-method groups. Facial temperatures were measured in six areas of the right and left forehead, maxilla, and mandible before and 30 min after completion of the transnasal SPGB. Temperatures were compared before and 30 min after SPGB in each group and between the two groups. VAS scores were compared at the same times of SPGB in each group and between the two groups. In the drip-method group, there were significant increases at four areas of the face in temperature changes at 30 min after SPGB. In the topical-method group, there was no significant difference in the temperature changes at 30 min after SPGB. There were statistically significant differences in the facial temperature changes between the two groups in the right forehead (p = 0.001), left forehead (p = 0.015), and right maxillary area (p = 0.046). In herpes zoster, there were statistically significant differences in the VAS scores between before and 30 min after SPGB in both groups (p < 0.001, p = 0.008) and between two groups (p < 0.001). In migraine, there were statistically significant differences in VAS scores between before and 30 min after SPGB in both groups (p < 0.001, p = 0.004) and between two groups (p = 0.014). Transnasal SPGB using two methods showed different temperature changes and VAS scores.

Bilateral Sphenopalatine Ganglion Block for the Treatment of Post Dural Puncture Headache: A Case Report

Background: Post dural puncture headache (PDPH) is a known and potentially debilitating complication of neuraxial anesthesia that can impede patient recovery. The conventional treatment includes hydration and symptomatic treatment like simple analgesics. Those who have unremitting symptoms following conservative measures are offered an epidural blood patch (EBP). However, EBP, an invasive procedure, is associated with complications in itself. Case: We report a 40-year-old man who experienced PDPH after spinal anesthesia. His symptoms recurred after conservative management was instituted. He was then offered a trans-nasal sphenopalatine ganglion (SPG) block. He had excellent pain relief and did not require an EBP. Conclusion: SPG blocks can be considered early in the treatment of PDPH together with general supportive measures. However, if pain relief is not achieved, an epidural blood patch should still be considered.

Transnasal Sphenopalatine Ganglion Block for Management of Postdural Puncture Headache in Non-Obstetric Patients.

This study investigated the efficacy and safety of transnasal sphenopalatine ganglion block (SPGB) for treatment of postural puncture headache (PDPH) in non-obstetric patients. This retrospective study was conducted at the Ankara Research and Educational Hospital, in Turkey, and included 26 non-obstetric patients (age, ≥18 years) who were diagnosed with PDPH and unresponsive to conservative therapy or unable to continue it because of side effects. Transnasal SPGB was performed in each nostril. Pain severity was assessed with the Visual Analogue Scale (VAS) at 15 min, 30 min, 24 h, and 48 h after the procedure, while patients were seated. The patients were monitored for 48 h for adverse effects (AEs). Patient treatment satisfaction was assessed at 48 h after the procedure by using the Patient Global Impression of Change (PGIC) scale. Headache at 15 min post-procedure was relieved rapidly. At 24 h post-procedure, nearly half of patients (42.3%) had no pain, and all patients (100%) had a VAS score of <3. Nasal discomfort, throat numbness, and nausea were AEs reported after SPGB; however, these AEs were completely relieved at 24 h after the procedure. According to the PGIC scale scores at 48 h post-procedure, 73.1% of patients evaluated themselves as "much improved" and 26.9% evaluated themselves as "very much improved". When PDPH does not respond to conservative treatment, it may be treated effectively with transnasal SPGB, which is a noninvasive, safe, well-tolerated, and straightforward method with a low complication rate.

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.

Verification of Sphenopalatine Ganglion Block Success Using Transcranial Doppler in Management of Patients with Postdural

Sphenopalatine ganglion block (SPGB) is traditionally advised in the management of head and neck pain. Since SPGB is a minimally invasive, repeatable, and simple technique, SPGB should be tried first in the management of postdural puncture headaches (PDPH). Verification of the block's success in diagnostic, prognostic, and therapeutic nerve blocks, is of paramount importance in pain management. This study intends to prove the ability of SPGB in the management of PDPH. Transcranial Doppler (TCD) is utilized as an objective measure to assess the block's success by monitoring variations in the cerebral hemodynamics before and after the block procedure. Noninvasive intracranial pressure (nICP) was applied to support the theory which assumes that the vasodilation of the cerebral blood vessels is the precipitating cause of the PDPH, rather than intracranial hypotension. Prospective, triple blinded, controlled, clinical trial. This clinical trial was conducted at Zagazig University. In the present study, 123 patients were considered who had spinal and/or epidural anesthesia; 63 patients who developed PDPH joined treatment group A and received the SPGB block. The control group B included 60 patients with no PDPH. The patients in group A were evaluated preprocedure by a numerical pain score and at 30 minutes, 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours postprocedure. Furthermore, patients in both groups were evaluated employing TCD before the transnasal block was given, then it was repeated to group A only within one hour after the block. Results analysis revealed that preprocedural pulsatility index (PI) and mean flow velocity (MFV) values in treatment group A were (mean ± standard deviation [SD]) 0.63 ± 0.04 and 57.20 ± 4.85 cm s-1, respectively. Values of PI and MFV were significantly increased up to (mean ± SD) 0.87 ± 0.08 and 71.15 ± 7.686 cm s-1, respectively after the block. The computed nICP values preblock and postblock were also within the normal range. Performing SPGB without standardized equipment may limit the results of the current studyCONCLUSIONS: SPGB should be considered as a first treatment modality for PDPH. Moreover, the results indicate that TCD is a successful objective tool in assessing a transnasal sphenopalatine ganglion block.

Sphenopalatine ganglion block for the treatment of postdural puncture headache: a randomised, blinded, clinical trial

BackgroundCurrent treatment of postdural puncture headache includes epidural blood patch (EBP), which is invasive and may result in rare but severe complications. Sphenopalatine ganglion block is suggested as a simple, minimally invasive treatment for postdural puncture headache. We aimed to investigate the analgesic effect of a transnasal sphenopalatine ganglion block with local anaesthetic vs saline. MethodsWe conducted a blinded, randomised clinical trial including adults fulfilling the criteria for EBP. Participants received a sphenopalatine ganglion block bilaterally with 1 ml of either local anaesthetic (lidocaine 4% and ropivacaine 0.5%) or placebo (saline). Primary outcome was pain in upright position 30 min post-block, measured on a 0–100 mm VAS. ResultsWe randomised 40 patients with an upright median pain intensity of 74 and 84 mm in the local anaesthetic and placebo groups at baseline, respectively. At 30 min after sphenopalatine ganglion block, the median pain intensity in upright position was 26 mm in the local anaesthetic group vs 37 mm in the placebo group (estimated median difference: 5 mm; 95% confidence interval: –14 to 21; P=0.53). In the local anaesthetic group, 50% required an EBP compared with 45% in the placebo group (P=0.76). ConclusionsAdministration of a sphenopalatine ganglion block with local anaesthetic had no statistically significant effect on pain intensity after 30 min compared with placebo. However, pain was reduced and EBP was avoided in half the patients of both groups, which suggests a major effect not necessarily attributable to local anaesthetics. Clinical trial registrationNCT03652714.

Treat PDPH (Post dural puncture headache) with sphenopalatine ganglion block: Transnasal approach

Background and Study Objective: To treat PDPH by simple and effective means using transnasal Sphenopalatine ganglion block. PDPH (post dural puncture headache) is one of the very well known complications. Management of PDPH is always challenging to anesthesiologist. Though the incidence of PDPH has reduced with new small spinal needles and needle tip designs, still occasional PDPH cases are observed.