Sphenopalatine Ganglion Nerve Block

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 < 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

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Lidocaine Versus Bupivacaine in the Treatment of Headache with Intranasal Sphenopalatine Nerve Block

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/423 ◽

2020 ◽

Vol 4;23 (7;4) ◽

pp. 423-427

Author(s):

Daniel L Kirkpatrick

Keyword(s):

Retrospective Study ◽

Nerve Block ◽

Study Design ◽

Treatment Options ◽

Treatment Success ◽

Tertiary Care ◽

Sphenopalatine Ganglion ◽

Pain Level ◽

Advantages And Disadvantages ◽

Significant Difference

Background: Intranasal sphenopalatine ganglion (SPG) block has been shown to be an effective treatment for headaches. Multiple therapeutic agents have been studied, although the wide availability and low cost of lidocaine and bupivacaine have made them attractive treatment options. To the authors knowledge, no study has yet demonstrated superiority of one anesthetic over the other. Objective: To determine the efficacy of lidocaine versus bupivacaine when performing intranasal sphenopalatine ganglion (SPG) block for the treatment of headaches. Study Design: Retrospective cohort study. Setting: A single tertiary care academic institution Methods: This retrospective study identified patients who underwent SPG block at a single institution from January 1, 2014 to December 20, 2017. Patients were included if they were treated with either lidocaine or bupivacaine and had both pre- and post-procedure pain scores recorded on a 0-10 scale. Patients were excluded if they were less than 18 years of age. Results: 386 total procedures were performed. 303 (78.5%) were lidocaine delivered via the SphenoCath device, and 83 (21.5%) were bupivacaine delivered via the Tx360 device. 90.2% of treatments (n = 348) decreased the patient’s pain level. Of the treatments performed with lidocaine, 89.1% (n = 270) resulted in improvement of the patient’s pain level with a mean decrease in pain level of 3.1 (SD ± 2.3). Of the treatments performed with bupivacaine, 94.0% (n = 78) resulted in improvement of the patient’s pain level, with a mean decrease in pain level of 3.0 (SD ± 1.9). No statistically significant difference was found between the 2 anesthetics. Limitations: The retrospective study design may introduce selection bias. Both lidocaine and bupivacaine were administered by different devices (Sphenocath and Tx360 respectively) which may account for differences in initial treatment success. There were differences in the size of the two groups, which may also introduce error. Conclusions: This study demonstrates similar efficacy of SPG block performed with lidocaine or bupivacaine. While no difference was found, the particular advantages and disadvantages of the intranasal delivery device may influence physician choice. Key words: Sphenopalatine ganglion nerve block, lidocaine, bupivacaine, sphenocath, Tx360, pain intervetnio, headache, miimally invasive therapy

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