Transnasal sphenopalatine ganglion block

Transnasal sphenopalatine ganglion block

Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
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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
• cluster headaches
• trigeminal neuralgia
• COVID-19 headaches
• facial pain syndromes
• post dural puncture headaches
• neck pain
• shoulder pain
• 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

System	Considerations
Airway	Evaluate nose to ensure there are no gross abnormalities

Labs and studiesNONE

Procedure room setup

• Option 1: "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

• Option 2: "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:

Procedure variants

	Variant 1	Variant 2
Unique considerations
Indications
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications