Transnasal sphenopalatine ganglion block

2022-10-07T02:28:41Z

DanielleLevinMD: Added citations. Added Procedure Description under "Overview." Added Preoperative management. Added description of how to set up/do the block.

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Transnasal sphenopalatine ganglion block is a procedure in which local anesthetic is delivered to a group of nerve cells, called the sphenopalatine ganglion, located behind the nose. The technique can be performed through the use of several commercially available devices, self assembly of cotton-tip applicators, or simply local anesthetic drops. The fascinating aspect of this block is that not only does it treat numerous pain conditions, but it may also provide long-term effect beyond the typical expected duration of local anesthetic.

==Overview==

===Indications===

* acute migraines
* chronic migraines<ref>{{Cite journal|last=Levin|first=Danielle|last2=Cohen|first2=Shaul|last3=Mellender|first3=Scott|last4=Kiss|first4=Geza|date=2018-07-15|title=Sphenopalatine Ganglion Block Successfully Treats Migraines in a Type 1 Arnold Chiari Malformation Pregnant Patient: A Case Report|url=https://pubmed.ncbi.nlm.nih.gov/29634560|journal=A&A Practice|volume=11|issue=2|pages=32–34|doi=10.1213/XAA.0000000000000722|issn=2575-3126|pmid=29634560}}</ref>
* cluster headaches
* trigeminal neuralgia
*COVID-19 headaches<ref>{{Cite journal|last=Levin|first=Danielle|last2=Acquadro|first2=Martin|last3=Cerasuolo|first3=Joseph|last4=Gerges|first4=Frederic J.|date=2022-06|title=Persistent Coronavirus Disease 2019 Headache Relieved with Sphenopalatine Ganglion Block|url=https://pubmed.ncbi.nlm.nih.gov/35775801|journal=Turkish Journal of Anaesthesiology and Reanimation|volume=50|issue=Supp1|pages=S68–S70|doi=10.5152/TJAR.2022.21318|issn=2667-677X|pmid=35775801}}</ref>
* facial pain syndromes
*post dural puncture headaches<ref>{{Cite journal|last=Cohen|first=Shaul|last2=Levin|first2=Danielle|last3=Mellender|first3=Scott|last4=Zhao|first4=Rong|last5=Patel|first5=Preet|last6=Grubb|first6=William|last7=Kiss|first7=Geza|date=2018-11|title=Topical Sphenopalatine Ganglion Block Compared With Epidural Blood Patch for Postdural Puncture Headache Management in Postpartum Patients: A Retrospective Review|url=https://pubmed.ncbi.nlm.nih.gov/30063655|journal=Regional Anesthesia and Pain Medicine|volume=43|issue=8|pages=880–884|doi=10.1097/AAP.0000000000000840|issn=1532-8651|pmid=30063655}}</ref><ref>{{Cite journal|last=Levin|first=Danielle|last2=Cohen|first2=Shaul|last3=Kiss|first3=Geza|last4=Mellender|first4=Scott|date=2019-03-02|title=Reply to Dr Araujo et al|url=https://pubmed.ncbi.nlm.nih.gov/30826744|journal=Regional Anesthesia and Pain Medicine|pages=rapm–2018–100189|doi=10.1136/rapm-2018-100189|issn=1532-8651|pmid=30826744}}</ref><ref>{{Cite journal|last=Levin|first=Danielle|last2=Cohen|first2=Shaul|last3=Grant|first3=Gilbert J.|date=2021-12|title=Sphenopalatine ganglion block for postdural puncture headache in the patient with challenging spinal anatomy|url=https://pubmed.ncbi.nlm.nih.gov/33483423|journal=Regional Anesthesia and Pain Medicine|volume=46|issue=12|pages=1115|doi=10.1136/rapm-2021-102473|issn=1532-8651|pmid=33483423}}</ref>
* neck pain
* shoulder pain<ref>{{Cite journal|last=Levin|first=Danielle|last2=Acquadro|first2=Martin|last3=Cerasuolo|first3=Joseph|last4=Gerges|first4=Frederic|date=2022-01-06|title=Sphenopalatine ganglion block for ipsilateral shoulder pain following open pancreaticoduodenectomy|url=https://pubmed.ncbi.nlm.nih.gov/34992061|journal=BMJ case reports|volume=15|issue=1|pages=e243746|doi=10.1136/bcr-2021-243746|issn=1757-790X|pmc=8739062|pmid=34992061}}</ref>
* chronic abdominal wall pain
* lower extremity complex regional pain syndrome
* post traumatic stress disorder

===Procedure===
The patient is positioned supine with cervical spine extension ("chin-up" position). If a patient becomes light-headed, experiences neck pain, or has a history of neck surgery, then the patient can be positioned in mild Trendelenburg position with neutral head position (no cervical spine extension). Each treatment part takes 15 minutes and can be repeated up to 3 times in a row during the session. For comfort, patient's eyes can be covered with a small towel. Some patients enjoy background music during treatment session.

==Preoperative management==

===Patient evaluation===
{| class="wikitable"
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Labs and studiesNONE

===Procedure room setup<ref>{{Cite journal|last=Levin|first=Danielle|last2=Cohen|first2=Shaul|date=2020-11|title=Images in anesthesiology: three safe, simple, and inexpensive methods to administer the sphenopalatine ganglion block|url=https://pubmed.ncbi.nlm.nih.gov/32784228|journal=Regional Anesthesia and Pain Medicine|volume=45|issue=11|pages=880–882|doi=10.1136/rapm-2020-101765|issn=1532-8651|pmid=32784228}}</ref>===

* '''<u>Option 1:</u> "Lidocaine Drops"'''
** '''''What is needed?'''''
*** Lidocaine solution (4% is typically used, but 2% works as well)
*** Syringe (5 mL syringe, 3 mL syringe, or 1 mL syringe)
** '''''How to administer the block?'''''
*** Draw up the lidocaine solution into the syringe
*** Drip the lidocaine solution from the syringe into one of the patient's nostrils until the patient feels the medication the back of the throat
*** Repeat the same process into the other nostril
*** Typically, it takes 0.5 mL to 1.5 mL of the medication for the patient to feel it in the back of the throat
*** Ask the patient to lie still for 15 minutes in the position described above
*** After 15 minutes, evaluate the patient's symptoms
** '''''Analysis of treatment:'''''
*** This is the most comfortable treatment methodology for patient
*** More than 70% of patients respond to this treatment methodology
*** If a patient does not respond to this treatment methodology, then the local anesthetic drops likely did not reach the sphenopalatine ganglion and one can continue with the other treatment methodologies described below

* '''<u>Option 2:</u> "Self-assembly of Cotton-tipped Applicators"'''
** '''''What is needed?'''''
*** Lidocaine solution (4% is typically used, but 2% works as well)
*** Lidocaine ointment (5% is typically used, but 2% also works)
*** '''2''' Syringes (5 mL syringes or 3 mL syringes)
*** Hollow cotton swabs
*** Intravenous extension tubing with a stopcock
*** Medical tape (optional)
** '''''How to set up the Applicators?'''''
***
** '''''Analysis of treatment:'''''
***

==Intraoperative management==

===Monitoring and access===

===Induction and airway management===

===Positioning===

===Maintenance and surgical considerations===

===Emergence===

==Postoperative management==

===Disposition===

===Pain management===

===Potential complications===

==Procedure variants==

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==References==

[[Category:Surgical procedures]]

Transnasal sphenopalatine ganglion block

2022-09-22T16:12:43Z

DanielleLevinMD: Started this new page. Wrote the following sections: Overview; Indications

WikiAnesthesia - User contributions [en]

Transnasal sphenopalatine ganglion block

Transnasal sphenopalatine ganglion block