Difference between revisions of "Transnasal sphenopalatine ganglion block"

From WikiAnesthesia
(Started this new page. Wrote the following sections: Overview; Indications)
 
(Added citations. Added Procedure Description under "Overview." Added Preoperative management. Added description of how to set up/do the block.)
 
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* acute migraines
* acute migraines
* chronic 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
* cluster headaches
* trigeminal neuralgia
* 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
* 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
* neck pain
* shoulder 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
* chronic abdominal wall pain
* lower extremity complex regional pain syndrome
* lower extremity complex regional pain syndrome
* post traumatic stress disorder
* post traumatic stress disorder


===Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. -->===
===Procedure<!-- Briefly describe the major steps of this surgical 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==
==Preoperative management==
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Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->NONE


===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->===
===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><!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->===
 
===Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->===


===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->===
* '''<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


===Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. -->===
* '''<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==
==Intraoperative management==

Latest revision as of 19:28, 6 October 2022

Transnasal sphenopalatine ganglion block
Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
Article quality
Editor rating
In development
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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[1]
  • cluster headaches
  • trigeminal neuralgia
  • COVID-19 headaches[2]
  • facial pain syndromes
  • post dural puncture headaches[3][4][5]
  • neck pain
  • shoulder pain[6]
  • 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[7]

  • 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:

Intraoperative management

Monitoring and access

Induction and airway management

Positioning

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

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

References

  1. Levin, Danielle; Cohen, Shaul; Mellender, Scott; Kiss, Geza (2018-07-15). "Sphenopalatine Ganglion Block Successfully Treats Migraines in a Type 1 Arnold Chiari Malformation Pregnant Patient: A Case Report". A&A Practice. 11 (2): 32–34. doi:10.1213/XAA.0000000000000722. ISSN 2575-3126. PMID 29634560.
  2. Levin, Danielle; Acquadro, Martin; Cerasuolo, Joseph; Gerges, Frederic J. (2022-06). "Persistent Coronavirus Disease 2019 Headache Relieved with Sphenopalatine Ganglion Block". Turkish Journal of Anaesthesiology and Reanimation. 50 (Supp1): S68–S70. doi:10.5152/TJAR.2022.21318. ISSN 2667-677X. PMID 35775801 Check |pmid= value (help). Check date values in: |date= (help)
  3. Cohen, Shaul; Levin, Danielle; Mellender, Scott; Zhao, Rong; Patel, Preet; Grubb, William; Kiss, Geza (2018-11). "Topical Sphenopalatine Ganglion Block Compared With Epidural Blood Patch for Postdural Puncture Headache Management in Postpartum Patients: A Retrospective Review". Regional Anesthesia and Pain Medicine. 43 (8): 880–884. doi:10.1097/AAP.0000000000000840. ISSN 1532-8651. PMID 30063655. Check date values in: |date= (help)
  4. Levin, Danielle; Cohen, Shaul; Kiss, Geza; Mellender, Scott (2019-03-02). "Reply to Dr Araujo et al". Regional Anesthesia and Pain Medicine: rapm–2018–100189. doi:10.1136/rapm-2018-100189. ISSN 1532-8651. PMID 30826744.
  5. Levin, Danielle; Cohen, Shaul; Grant, Gilbert J. (2021-12). "Sphenopalatine ganglion block for postdural puncture headache in the patient with challenging spinal anatomy". Regional Anesthesia and Pain Medicine. 46 (12): 1115. doi:10.1136/rapm-2021-102473. ISSN 1532-8651. PMID 33483423. Check date values in: |date= (help)
  6. Levin, Danielle; Acquadro, Martin; Cerasuolo, Joseph; Gerges, Frederic (2022-01-06). "Sphenopalatine ganglion block for ipsilateral shoulder pain following open pancreaticoduodenectomy". BMJ case reports. 15 (1): e243746. doi:10.1136/bcr-2021-243746. ISSN 1757-790X. PMC 8739062 Check |pmc= value (help). PMID 34992061 Check |pmid= value (help).
  7. Levin, Danielle; Cohen, Shaul (2020-11). "Images in anesthesiology: three safe, simple, and inexpensive methods to administer the sphenopalatine ganglion block". Regional Anesthesia and Pain Medicine. 45 (11): 880–882. doi:10.1136/rapm-2020-101765. ISSN 1532-8651. PMID 32784228. Check date values in: |date= (help)