Sphenopalatine Ganglion Nerve Block for the Treatment of Migraine Headaches in the Pediatric Population

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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The effect of preoperative local anaesthetic nerve block in patients undergoing endonasal surgery: A prospective pilot study assessing postoperative pain control in patients undergoing preoperative combined sphenopalatine ganglion (SPG) and anterior ethmoidal nerve (AEN) local anaesthetic block.

10.26226/morressier.5adde3c4d462b80290b59897 ◽

2018 ◽

Author(s):

Eamon Shamil

Keyword(s):

Pilot Study ◽

Postoperative Pain ◽

Nerve Block ◽

Local Anaesthetic ◽

Pain Control ◽

Sphenopalatine Ganglion ◽

Postoperative Pain Control ◽

Endonasal Surgery ◽

Prospective Pilot Study ◽

Anaesthetic Block

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The Public’s Perception of Interventions for Migraine Headache Disorders: A Crowdsourcing Population-Based Study

Aesthetic Surgery Journal Open Forum ◽

10.1093/asjof/ojz007 ◽

2019 ◽

Vol 1 (2) ◽

Cited By ~ 5

Author(s):

Orr Shauly ◽

Daniel J Gould ◽

Ketan M Patel

Keyword(s):

Migraine Headache ◽

Treatment Options ◽

The United States ◽

Cost Of Care ◽

Adverse Outcomes ◽

Amazon Mechanical Turk ◽

Cross Sectional ◽

Economic Productivity ◽

Migraine Headaches ◽

Patient Reported

Abstract Background Migraine disorders are a leading cause of morbidity and decreased economic productivity in the United States among both men and women. As such, it is important to consider patient opinions, and have an accurate representation of the burden and sentiment toward currently available interventions among those suffering from migraines. Objectives The aim of the study was to assess patient options regarding adverse outcomes of the various treatment options available for migraine headaches. Methods A prospective cross-sectional study of volunteers recruited through an internet crowdsourcing service, Amazon Mechanical Turk©, was conducted. Surveys were administered to collect patient-reported opinions regarding adverse outcomes of both surgical and nonsurgical treatment options for migraine headaches. Results The prevalence of migraine headache across all study participants was 15.6% and varied slightly across participant demographics. Individuals ages 35–44 (2.73 migraines per month) experienced the fewest migraine and with the lowest severity. Those individuals ages 45+ experienced the most severe headaches (Visual Analog Scale = 44.23 mm). Additionally, the greatest migraine frequency and severity existed among those households with yearly income of $75,000–$100,000. The lowest injection therapy utility scores were obtained for adverse outcomes of hematoma (47.60 mm) and vertigo (54.40 mm). Conclusions Migraine headaches remains a significant problem among the US population, with an overall prevalence of 15.6% (approximately 50 million Americans). Additionally, physicians interesting in offering minimally invasive or surgical treatment for migraine headaches should focus on mitigating patient fears regarding clinical outcomes and cost of care.

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Surgical Management of Pediatric Gastroesophageal Reflux Disease

Gastroenterology Research and Practice ◽

10.1155/2013/863527 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Hope T. Jackson ◽

Timothy D. Kane

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Surgical Management ◽

Reflux Disease ◽

Clinical Presentation ◽

Pediatric Population ◽

Treatment Options ◽

Failure To Thrive ◽

Solid Diet ◽

Esophageal Sphincter

Gastroesophageal reflux (GER) is common in the pediatric population. Most cases represent physiologic GER and as the lower esophageal sphincter (LES) matures and a solid diet is introduced, many of these patients (>65%) experience spontaneous resolution of symptoms by two years of age. Those who continue to have symptoms and develop complications such as failure to thrive, secondary respiratory disease, and others are classified as having gastroesophageal reflux disease (GERD). Goals of GERD treatment include the resolution of symptoms and prevention of complications. Treatment options to achieve these goals include dietary or behavioral modifications, pharmacologic intervention, and surgical therapy. This paper will review the clinical presentation of GERD and discuss options for surgical management and outcomes in these patients.

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A Retrospective Review of Femoral Nerve Block for Postoperative Analgesia After Knee Surgery in the Pediatric Population

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000000113 ◽

2014 ◽

Vol 34 (4) ◽

pp. 459-461 ◽

Cited By ~ 13

Author(s):

Brian Schloss ◽

Tarun Bhalla ◽

Kevin Klingele ◽

Daniel Phillips ◽

Bradley Prestwich ◽

...

Keyword(s):

Nerve Block ◽

Postoperative Analgesia ◽

Retrospective Review ◽

Femoral Nerve Block ◽

Pediatric Population ◽

Femoral Nerve ◽

Knee Surgery

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A Prospective Study of Shiga-Like Toxin-Associated Diarrhea in a Pediatric Population

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/00005176-199408000-00004 ◽

1994 ◽

Vol 19 (2) ◽

pp. 164-169 ◽

Cited By ~ 10

Author(s):

Rodolfo E. Bégué ◽

Marguerite A. Neill ◽

Elaine F. Papa ◽

Penelope H. Dennehy

Keyword(s):

Prospective Study ◽

Pediatric Population ◽

A Prospective Study

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Validation of the Headache Impact Test (HIT-6™) across episodic and chronic migraine

Cephalalgia ◽

10.1177/0333102410379890 ◽

2010 ◽

Vol 31 (3) ◽

pp. 357-367 ◽

Cited By ~ 146

Author(s):

Min Yang ◽

Regina Rendas-Baum ◽

Sepideh F Varon ◽

Mark Kosinski

Keyword(s):

Chronic Migraine ◽

Discriminant Validity ◽

High Reliability ◽

Reliability And Validity ◽

Episodic Migraine ◽

Migraine Headaches ◽

Scale Scores ◽

Headache Pain ◽

Test Retest Reliability ◽

Headache Impact

Objective: The purpose of this study was to assess psychometric properties of the six-item Headache Impact Text (HIT-6™) across episodic and chronic migraine. Methods: Using a migraine screener and number of headache days per month (HDPM), participants from the National Survey of Headache Impact (NSHI) study and the HIT-6 validation study (HIT6-V) were selected for this study. Eligible participants were categorized into three groups: chronic migraine (CM: ≥ 15 HDPM); episodic migraine (EM: < 15 HDPM); non-migraine headaches. Reliability and validity of the HIT-6 were evaluated. Results: A total of 2,049 survey participants met the inclusion/exclusion criteria for this study. Participants were identified as 6.4% CM; 42.1% EM; 51.5% non-migraine, with respective mean HIT-6 scores: 62.5 ± 7.8; 60.2 ± 6.8; and 49.1 ± 8.7. High reliability was demonstrated with internal consistency (time1/time2) of 0.83/0.87 in NSHI, and 0.82/0.92 in HIT6-V. Intra-class correlation for test-retest reliability was very good at 0.77. HIT-6 scores correlated significantly ( p < .0001) with total Migraine Disability Assessment Scale scores ( r = 0.56), headache pain severity ( r = 0.46), and HDPM ( r = 0.29). Discriminant validity analysis showed significantly different HIT-6 scores ( F = 488.02, p < .0001) across the groups. Conclusion: Results from these analyses confirm that the HIT-6 is a reliable and valid tool for discriminating headache impact across episodic and chronic migraine.

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OBTURATOR NERVE RLOCK

The Professional Medical Journal ◽

10.29309/tpmj/2009.16.01.2972 ◽

2009 ◽

Vol 16 (01) ◽

pp. 48-52

Author(s):

NASEEM AHMED ◽

Shahid Mahmood Rana ◽

SYED MUHAMMAD ZAHEER HAIDER ◽

Arshad Mahmood ◽

FAIZAN AHMED ◽

...

Keyword(s):

Nerve Block ◽

Spinal Anaesthesia ◽

Bladder Wall ◽

Obturator Nerve ◽

Physical Status ◽

Effective Technique ◽

Obturator Nerve Block ◽

Partial Suppression ◽

A Prospective Study ◽

Study Setting

Objectives: To evaluate the efficacy of obturator nerve block combined with spinal anaesthesia for prevention of adductormuscle spasm and its associated complications during transurethral resection of bladder tumours located at its lateral and inferolateral wall.Study design: A prospective study. Setting: At AFIU Rawalpindi. Period: From January 2005 to December 2006. Material and methodFifty patients who had tumours at their lateral / inferolateral bladder wall of physical status ASA I - IV received spinal anaesthesia at 3r d or4l h lumbar space followed by obturator nerve block with a view to preventing adductor jerk during resection of tumour. Results: There wascomplete suppression of adductor jerk in 45 (90%) patients and surgery was completed smoothly. Two patients (4%) had mild adductorjerk and additional sedation was required. The block failed to work in 3 (6%) cases and required conversion to general anaesthesia. Thusthe procedure was successful in 94% (complete and partial suppression of jerk. Conclusion: We conclude that spinal anaesthesiacombined with obturator nerve block is an effective technique for preventing adductor jerk during TUR-BT, thus avoiding intra-operative andpost operative complication.

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