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Gökçek E, Kozan G. Postoperative effects of bilateral sphenopalatine ganglion blockade in septorhinoplasty operations; double-blind randomized clinical trial. Braz J Otorhinolaryngol 2024; 90:101373. [PMID: 38113753 PMCID: PMC10767143 DOI: 10.1016/j.bjorl.2023.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE We aimed to investigate the effect of bilateral sphenopalatine ganglion blockade (SPGB) on the main postoperative complications in septorhinoplasty operations. METHODS In this randomized, controlled, prospective study, 80 cases planned for Septorhinoplasty operations under general anesthesia were included in the study. The cases were divided into two groups; SPGB was performed with 2 mL of 0.25% bupivacaine bilaterally 15 min before the end of the operation in the SPGB group (Group S, n = 40). In the control group (Group C, n = 40), 2 mL of 0.9% NaCl solution was applied into both SPG areas. In the recovery unit after the operation; the pain and analgesic needs of the patients at 0, 2, 6 and 24 h were evaluated. RESULTS There was no statistically significant difference between the groups in terms of hemodynamic parameters (ASA, MBP, HR) (p > 0.05) All VAS values were statistically lower in Group S than in Group C (p < 0.05). In Group S, the need for analgesic medication was found in 5 cases between 0-2 h, whereas in Group C, this rate was found in 17 cases, and it was statistically significant (p < 0.05). CONCLUSION Bilateral SPGB application was determined to provide better analgesia in the early postoperative period compared to the control group, it was concluded that further studies are needed to say that there are significant effects on laryngospasm and nausea-vomiting. LEVEL OF EVIDENCE 2, degree of recommendation B.
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Affiliation(s)
- Erhan Gökçek
- Health Sciences University Diyarbakir Gazi Yasargil Research and Education Hospital, Department of Anaesthesiolgy and Reanimation, Diyarbakir, Turkey.
| | - Gunay Kozan
- Dicle University, Faculty of Medicine, Department of Otorhinolaryngology, Diyarbakir, Turkey
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2
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Boezaart AP, Smith CR, Zasimovich Y, Przkora R, Kumar S, Nin OC, Boezaart LC, Botha DA, Leonard A, Reina MA, Pareja JA. Refractory primary and secondary headache disorders that dramatically responded to combined treatment of ultrasound-guided percutaneous suprazygomatic pterygopalatine ganglion blocks and non-invasive vagus nerve stimulation: a case series. Reg Anesth Pain Med 2024; 49:144-150. [PMID: 37989499 DOI: 10.1136/rapm-2023-104967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
In 1981, Devoghel achieved an 85.6% success rate in treating patients with treatment-refractory cluster headaches with alcoholization of the pterygopalatine ganglion (PPG) via the percutaneous suprazygomatic approach. Devoghel's study led to the theory that interrupting the parasympathetic pathway by blocking its transduction at the PPG could prevent or treat symptoms related to primary headache disorders (PHDs). Furthermore, non-invasive vagus nerve stimulation (nVNS) has proven to treat PHDs and has been approved by national regulatory bodies to treat, among others, cluster headaches and migraines.In this case series, nine desperate patients who presented with 11 longstanding treatment-refractory primary headache disorders and epidural blood patch-resistant postdural puncture headache (PDPH) received ultrasound-guided percutaneous suprazygomatic pterygopalatine ganglion blocks (PPGB), and seven also received nVNS. The patients were randomly selected and were not part of a research study. They experienced dramatic, immediate, satisfactory, and apparently lasting symptom resolution (at the time of the writing of this report). The report provides the case descriptions, briefly reviews the trigeminovascular and neurogenic inflammatory theories of the pathophysiology, outlines aspects of these PPGB and nVNS interventions, and argues for adopting this treatment regime as a first-line or second-line treatment rather than desperate last-line treatment of PDPH and PHDs.
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Affiliation(s)
- Andre P Boezaart
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- Lumina Health, Surrey, UK
| | - Cameron R Smith
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Yury Zasimovich
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Rene Przkora
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sanjeev Kumar
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Olga C Nin
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | | | - André Leonard
- Private Neurology Practice, Mossel Bay, South Africa
| | - Miguel A Reina
- Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
- Anesthesiology, CEU San Pablo University Faculty of Medicine, Madrid, Spain
| | - Juan A Pareja
- Neurology, Hospital Universitario Quirón Madrid, Madrid, Spain
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3
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Karaoğullarından A, Erkan SO, Ekici NY. Is transoral sphenopalatine ganglion blockade more effective on postoperative pain than endoscopic sphenopalatine ganglion blockade? Eur Arch Otorhinolaryngol 2024; 281:193-199. [PMID: 37697038 DOI: 10.1007/s00405-023-08174-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/31/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE In this study, we aimed to examine and compare the effects of endoscopic SPGB and transoral SPGB on postoperative pain control and patient satisfaction in patients undergoing septoplasty. METHODS Participants were randomly divided into three groups, no blockade (n:20), endoscopic SPGB (n:20), and transoral SPGB (n:20). Those who had no blockage were included in the control group. Demographic data of patients, such as age and sex, VAS (visual analogue scale) and postoperative pain scores (PPS) [determined at arrival in the post-anesthesia care unit (PACU) and after 2, 6, 12, and 24 h], general analgesic use (24 and 168 h after surgery) and postoperative Quality of Recovery (QoR-15) values were recorded and compare them. RESULTS The PPS PACU of 2 h, 6 h, 12 h, and 24-h values of the transoral group were lower than the endoscopic and control groups (p < 0.001).The values of 24 h and 168 h of analgesic use in the transoral group were lower than in the control and endoscopic groups (p < 0.001).The average recovery QoR-15 scores at 12 h and 24 h differed according to the groups (p < 0.001) and the highest values were in the transoral group (p < 0.001). CONCLUSION Transoral SPGB is more effective in postoperative pain control than endoscopic SPGB, it decreases the use of postoperative analgesics and improves postoperative recovery scores.
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Affiliation(s)
- Ayşe Karaoğullarından
- ENT Specialist in Adana City Training and Research Hospital ENT Department, 01060, Yüreğir, Adana, Turkey.
| | - Sanem Okşan Erkan
- ENT Specialist in Adana City Training and Research Hospital ENT Department, 01060, Yüreğir, Adana, Turkey
| | - Nur Yücel Ekici
- ENT Specialist in Adana City Training and Research Hospital ENT Department, 01060, Yüreğir, Adana, Turkey
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Mantovani G, Sgarbanti L, Indaimo A, Cavallo MA, De Bonis P, Flacco ME, Scerrati A. Effects of a sphenopalatine ganglion block on postcraniotomy pain management: a randomized, double-blind, clinical trial. Neurosurg Focus 2023; 55:E13. [PMID: 38262005 DOI: 10.3171/2023.9.focus23549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/28/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Postcraniotomy pain (PCP) is a common finding after neurosurgical procedures, occurring in as many 87% of patients. The sphenopalatine ganglion (SPG) has a pivotal role in several headache syndromes, and its anesthetic block is currently used in different clinical conditions with benefit. The aim of this study was to evaluate the efficacy of an SPG block (SPGB) via a transnasal approach as adjunctive therapy in reducing pain scores during the postcraniotomy period. METHODS In this single-center, double-blind, randomized controlled trial, patients undergoing elective surgery with a supratentorial craniotomy were randomly assigned to a scalp block, local anesthetic infiltration of the wound, and systemic analgesia during the first 48 postoperative hours (standard therapy), or to standard therapy as well as an SPGB (experimental therapy). According to the available evidence, assuming a 50% reduction in the incidence of the main outcome in patients with an SPGB (vs standard treatment), 82 patients were needed to achieve 80% statistical power in an intent-to-treat analysis. Pain intensity was recorded during the first 180 postoperative days at selective time points (5 times in the hospital, 3 times by telephone interview) with different pain rating systems (a visual analog scale [VAS], numeric rating scale [NRS], and pain assessment in advanced dementia [PAINAD] scale), together with demographic, clinical, and surgical variables and complications. Heart rate and blood pressure were recorded during surgery. Differences in all variables were evaluated using a paired t-test and confirmed through Wilcoxon matched-pairs signed-rank and Kruskal-Wallis tests. RESULTS No complications occurred among the 83 patients enrolled. Statistically significant differences were found in the mean VAS score at postoperative days 0 (p = 0.05), 2 (p = 0.03), and 3 (p = 0.03). The PAINAD scale score showed significant differences between groups at postoperative days 1 (p = 0.006), 2 (p = 0.001), 3 (p = 0.03), and 4 (p = 0.05). The proportion of patients reporting a VAS score ≥ 3 in the first day after surgery was lower in the SPGB group than in the standard treatment group (71.9% vs 89.5%), although this difference did not reach statistical significance. At postoperative day 180, 5 patients (2 in the control group, 3 in the treatment group) had developed chronic PCP (NRS score ≥ 3). CONCLUSIONS SPGB is a safe and effective procedure as an adjunctive treatment for PCP management in elective supratentorial craniotomy during the first 4 postoperative days compared with standard therapy. Further studies are needed to better define the clinical impact of SPGB use and its indications. Clinical trial registration no.: NCT05136625 (ClinicalTrials.gov).
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Affiliation(s)
- Giorgio Mantovani
- 1Department of Translational Medicine, Neurosurgery Unit, University of Ferrara
- 2Department of Neurosurgery, University Hospital S. Anna of Ferrara; and
| | - Lorenzo Sgarbanti
- 1Department of Translational Medicine, Neurosurgery Unit, University of Ferrara
- 2Department of Neurosurgery, University Hospital S. Anna of Ferrara; and
| | - Antonino Indaimo
- 1Department of Translational Medicine, Neurosurgery Unit, University of Ferrara
- 2Department of Neurosurgery, University Hospital S. Anna of Ferrara; and
| | - Michele Alessandro Cavallo
- 1Department of Translational Medicine, Neurosurgery Unit, University of Ferrara
- 2Department of Neurosurgery, University Hospital S. Anna of Ferrara; and
| | - Pasquale De Bonis
- 1Department of Translational Medicine, Neurosurgery Unit, University of Ferrara
- 2Department of Neurosurgery, University Hospital S. Anna of Ferrara; and
| | - Maria Elena Flacco
- 3Department of Environmental and Preventive Sciences, University of Ferrara, Italy
| | - Alba Scerrati
- 1Department of Translational Medicine, Neurosurgery Unit, University of Ferrara
- 2Department of Neurosurgery, University Hospital S. Anna of Ferrara; and
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Mao-Jiang Y, Bhetuwal A, Xian Q, Xiao-Xue X. CT-guided ozone injection combined with sphenopalatine ganglion block for the treatment of atypical facial pain. Asian J Surg 2023; 46:5784-5786. [PMID: 37684122 DOI: 10.1016/j.asjsur.2023.08.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Affiliation(s)
- Yang Mao-Jiang
- Department of Pain, Affifiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Anup Bhetuwal
- Department of Pain, Affifiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Qiong Xian
- Department of Pain, Affifiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Xu Xiao-Xue
- Department of Pain, Affifiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China.
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Koenig NI, McGuire JA, Shackleford VP, Bauer K. Reactivation of Herpes Simplex Virus Following Sphenopalatine Ganglion Nerve Block: Case Report and Review of the Literature. A A Pract 2023; 17:e01719. [PMID: 37870295 PMCID: PMC10609693 DOI: 10.1213/xaa.0000000000001719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 10/24/2023]
Abstract
A 36-year-old woman with no significant past medical history underwent a sphenopalatine ganglion block for treatment of a month-long migraine headache refractory to conservative treatment protocols. The headache resolved initially, but 1 day following the procedure, the headache recurred. The patient also developed an erythematous and edematous rash which cultures confirmed to be herpes simplex virus (HSV). Following several unsuccessful treatment modalities, the patient received valacyclovir, which resulted in resolution of her headache. Underlying HSV-1 infection may cause intractable migraine headache and nerve blocks may potentiate reactivation of latent HSV infection that caused the skin lesion in this case.
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Affiliation(s)
- Nicholas I. Koenig
- From the West Virginia University School of Medicine, Morgantown, West Virginia
| | - Joseph A. McGuire
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Violet P. Shackleford
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Kelsey Bauer
- Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, West Virginia
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Levin D, Gerges FJ, Acquadro M. The versatility of the transnasal sphenopalatine ganglion block. Pain Med 2023; 24:1020. [PMID: 36808289 DOI: 10.1093/pm/pnad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Affiliation(s)
- Danielle Levin
- Department of Anesthesia, St. Elizabeth's Medical Center, Brighton, MA 02135, United States
| | - Frederic J Gerges
- Department of Anesthesia, St. Elizabeth's Medical Center, Brighton, MA 02135, United States
| | - Martin Acquadro
- Department of Anesthesia, St. Elizabeth's Medical Center, Brighton, MA 02135, United States
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8
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Ferjani M, Baud M, Pelen F, Schilte C, Payen JF. Bilateral Sphenopalatine Ganglion Block for Postoperative Spinal Dural Tear. Pain Med 2023; 24:466-467. [PMID: 36165689 DOI: 10.1093/pm/pnac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Malik Ferjani
- Department of Anaesthesia and Critical Care, Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Mariette Baud
- Department of Anaesthesia and Critical Care, Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Félix Pelen
- Department of Anaesthesia and Critical Care, Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Clotilde Schilte
- Department of Anaesthesia and Critical Care, Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Francois Payen
- Department of Anaesthesia and Critical Care, Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
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9
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Thomas J, Lal S, Chua ZH. Sphenopalatine Ganglion Block (SPGB) and Greater Occipital Nerve Block. Ir Med J 2023; 116:738. [PMID: 37555806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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Abstract
BACKGROUND Post COVID-19 syndrome (PC-19S) appears to be independent of acute illness severity and humoral response. The involvement of the autonomic nervous system (ANS), expressed by dysautonomia, has been hypothesized as a contributor. Several studies have associated the therapeutic effects of local anesthetics (LA) to their action on the ANS. To the best of our knowledge, this is the first report of therapeutic injections with LA linked to clinical improvement in a patient with PC-19S. PATIENT CONCERNS AND DIAGNOSES This was a 54-year-old-man with postCOVID-19 symptoms lasting 14 weeks, including fatigue, breathlessness, diarrhea, muscle pain, and emotional lability. INTERVENTIONS AND OUTCOME Injections of 0.5% procaine in the stellate ganglion (SG) and sphenopalatine ganglion (SPG), and in clinically relevant points in the scalp, thorax, and abdomen were performed 3 times over 3 months. The patient reported progressive improvement and was asymptomatic upon completing the treatment. Prescribed medications were discontinued. The 36-Item Short Form Health Survey (SF-36) score showed significant improvement across all SF-36-domains. CONCLUSION Subanesthetic doses of LA injected in clinically relevant points led to rapid and complete symptom resolution in this patient with PC-19S. Targeted LA injections may have therapeutic benefits in PC-19S and in other chronic diseases linked to stress and inflammation.
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Affiliation(s)
- David Vinyes
- Institute of Neural Therapy and Regulatory Medicine, Sabadell, Barcelona, Spain
- Campus Docent de Sant Joan de Déu, Barcelona, Spain
- Neural Therapy Research Foundation, Sabadell, Barcelona, Spain
| | - Montserrat Muñoz-Sellart
- Institute of Neural Therapy and Regulatory Medicine, Sabadell, Barcelona, Spain
- Campus Docent de Sant Joan de Déu, Barcelona, Spain
- Neural Therapy Research Foundation, Sabadell, Barcelona, Spain
| | - Teresa García Caballero
- Institute of Neural Therapy and Regulatory Medicine, Sabadell, Barcelona, Spain
- Campus Docent de Sant Joan de Déu, Barcelona, Spain
- Neural Therapy Research Foundation, Sabadell, Barcelona, Spain
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Havlik S, Chino K, Lebenson J, Cagniart P, Hamersley E, Haldeman M. Bilateral Sphenopalatine Ganglion Block With Liposomal Bupivacaine Followed by Severe Hypertension: A Case Report. A A Pract 2022; 16:e01574. [PMID: 35324513 DOI: 10.1213/xaa.0000000000001574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We reviewed a case of bilateral sphenopalatine ganglion (SPG) blockade with liposomal bupivacaine for sinus surgery. The case was complicated by severe postoperative hypertension refractory to antihypertensives and needing intensive care unit (ICU) admission. While SPG blockade has been used to treat headaches and provide perioperative analgesia, this complication and a possible mechanism have not been described. We discuss how local anesthetic spread beyond the SPG may have caused prolonged parasympathetic blockade and hypertension. Before approved indications are established, we recommend avoiding the use of liposomal bupivacaine in off-label settings when the function of bilateral autonomic structures could be affected.
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Affiliation(s)
- Steven Havlik
- From the University of Utah Medical School, Salt Lake City, Utah
| | - Kumiko Chino
- Department of Anesthesiology, University of Utah Medical Center, Salt Lake City, Utah
| | - Joshua Lebenson
- Department of Anesthesiology, United States Naval Hospital, Yokosuka, Japan
| | - Pierre Cagniart
- Department of Anesthesiology, Naval Hospital, Jacksonville, Florida
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Lo CYF, Le S, Kim E. Sphenopalatine Ganglion Block for Postdural Puncture Headaches in a Thrombocytopenic Adolescent Young Adult: A Case Report. J Pediatr Hematol Oncol 2022; 44:e299-e301. [PMID: 34986135 DOI: 10.1097/mph.0000000000002280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
The epidural blood patch is the gold-standard therapy to treat postdural puncture headaches from dural puncture when conservative therapies fail. However, an epidural blood patch is contraindicated in patients with coagulopathy and thrombocytopenia (platelet count of 60,000/µL) due to concerns of an epidural hematoma. We present a case of an adolescent with acute lymphocytic leukemia, thrombocytopenia, and persistent postdural puncture headaches. The patient was successfully treated with a sphenopalatine ganglion nerve block at the bedside without any side effects and complications.
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Abdelhaleem Abdelhaleem NF. Verification of Sphenopalatine Ganglion Block Success Using Transcranial Doppler in Management of Patients with Postdural. Pain Physician 2021; 24:E661-E668. [PMID: 34323454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Sphenopalatine ganglion block (SPGB) is traditionally advised in the management of head and neck pain. Since SPGB is a minimally invasive, repeatable, and simple technique, SPGB should be tried first in the management of postdural puncture headaches (PDPH). Verification of the block's success in diagnostic, prognostic, and therapeutic nerve blocks, is of paramount importance in pain management. OBJECTIVES This study intends to prove the ability of SPGB in the management of PDPH. Transcranial Doppler (TCD) is utilized as an objective measure to assess the block's success by monitoring variations in the cerebral hemodynamics before and after the block procedure. Noninvasive intracranial pressure (nICP) was applied to support the theory which assumes that the vasodilation of the cerebral blood vessels is the precipitating cause of the PDPH, rather than intracranial hypotension. STUDY DESIGN Prospective, triple blinded, controlled, clinical trial. SETTING This clinical trial was conducted at Zagazig University. METHODS In the present study, 123 patients were considered who had spinal and/or epidural anesthesia; 63 patients who developed PDPH joined treatment group A and received the SPGB block. The control group B included 60 patients with no PDPH. The patients in group A were evaluated preprocedure by a numerical pain score and at 30 minutes, 2 hours, 4 hours, 6 hours, 12 hours, and 24 hours postprocedure. Furthermore, patients in both groups were evaluated employing TCD before the transnasal block was given, then it was repeated to group A only within one hour after the block. RESULTS Results analysis revealed that preprocedural pulsatility index (PI) and mean flow velocity (MFV) values in treatment group A were (mean ± standard deviation [SD]) 0.63 ± 0.04 and 57.20 ± 4.85 cm s-1, respectively. Values of PI and MFV were significantly increased up to (mean ± SD) 0.87 ± 0.08 and 71.15 ± 7.686 cm s-1, respectively after the block. The computed nICP values preblock and postblock were also within the normal range. LIMITATIONS Performing SPGB without standardized equipment may limit the results of the current studyCONCLUSIONS: SPGB should be considered as a first treatment modality for PDPH. Moreover, the results indicate that TCD is a successful objective tool in assessing a transnasal sphenopalatine ganglion block.
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Youssef HA, Abdel-Ghaffar HS, Mostafa MF, Abbas YH, Mahmoud AO, Herdan RA. Sphenopalatine Ganglion versus Greater Occipital Nerve Blocks in Treating Post-Dural Puncture Headache after Spinal Anesthesia for Cesarean Section: A Randomized Clinical Trial. Pain Physician 2021; 24:E443-E451. [PMID: 34213869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite being invasive, with serious complications, epidural blood patch (EBP) is still considered the gold standard therapy for Post Dural Puncture Headache (PDPH). The use of Peripheral nerve blocks for PDPH are studied here. OBJECTIVES To investigate the efficacy of sphenopalatine ganglion block (SPGB) and greater occipital nerve block (GONB) to relieve PDPH and its associated symptoms. STUDY DESIGN Randomized comparative single-blind trial. SETTING A University hospital. METHODS Patients who received spinal anesthesia for elective cesarean section, and then developed PDPH during hospitalization or within 5 days after dural puncture were enrolled to receive GONB (n = 47) or SPGB (n = 46) for treatment of PDPH. GONB Group: Patients received bilateral GONB using 3 mL mixture of 2 mL lidocaine 2% plus 1 mL dexamethasone 4 mg on each side of occipital region. SPGB Group: Patients received bilateral SPGB using the same mixture in each nostril. Assessments included Numeric Rating Scale (NRS) for severity of headache at supine and sitting positions, nausea NRS, neck stiffness, need for EBP, and complications. RESULTS The supine and sitting headache NRS scores significantly decreased at 30 minutes after blocks and throughout follow-up period in both groups (P < 0.000). Clinically significant drop of NRS to < 4 was reached earlier in GONB group. There was a significant difference between groups after 2 hours in supine and sitting headache NRS scores (P = 0.020 and 0.030, respectively); however, both treatments showed similar effectiveness from the third hour afterwards (P > 0.05). Both techniques were effective in relieving neck stiffness and nausea (P < 0.000), with no adverse effects. LIMITATIONS A limitation to this study was the small sample size. CONCLUSIONS GONB and SPGB are equally effective in relieving symptoms of PDPH. Both techniques are safe, simple, and less invasive than EBP.
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Affiliation(s)
- Hamby Abbas Youssef
- Department of Anesthesia and Intensive Care, Assiut University, Assiut , Egypt
| | - Hala Saad Abdel-Ghaffar
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Yara Hamby Abbas
- Department of Anesthesia and Intensive Care, Assiut University, Assiut , Egypt
| | - Ahmed Omar Mahmoud
- Department of Anesthesia and Intensive Care, Assiut University, Assiut , Egypt
| | - Ragaa Ahmed Herdan
- Department of Anesthesia and Intensive Care, Assiut University, Assiut , Egypt
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15
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Hung KC, Chen JY, Ho CN, Sun CK. Use of sphenopalatine ganglion block in patients with postdural puncture headache: a pilot meta-analysis. Br J Anaesth 2020; 126:e25-e27. [PMID: 33131755 DOI: 10.1016/j.bja.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan; College of Medicine, I-Shou University, Kaohsiung, Taiwan.
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Anthony Cometa M, Zasimovich Y, Smith CR. Percutaneous sphenopalatine ganglion block: an alternative to the transnasal approach. Int J Obstet Anesth 2020; 45:163-164. [PMID: 33199256 PMCID: PMC7567671 DOI: 10.1016/j.ijoa.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/10/2020] [Accepted: 10/06/2020] [Indexed: 12/02/2022]
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Yoshida K. Sphenopalatine Ganglion Block with Botulinum Neurotoxin for Treating Trigeminal Neuralgia Using CAD/CAM-Derived Injection Guide. J Oral Facial Pain Headache 2019; 34:135–140. [PMID: 31560737 DOI: 10.11607/ofph.2510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To examine the effectiveness and safety of using a CAD/CAM-derived injection guide for botulinum neurotoxin block of the sphenopalatine ganglion for trigeminal neuralgia treatment. METHODS Ten patients with second-division trigeminal neuralgia who did not respond to submucosal administration of botulinum neurotoxin were enrolled in this study. The target point around the sphenopalatine fossa was determined after fusion of computed tomography data with a scan of a maxillary model using a software program for dental implant surgery. A CAD/CAM-derived injection guide was fabricated. The guide was affixed to the patient's maxilla, and a needle was inserted to an exactly analyzed depth. Subsequently, 50 units of botulinum neurotoxin were injected. Pain intensity evaluated using a visual analog scale and pain frequency were measured. RESULTS By using the guides, sphenopalatine ganglion block with botulinum toxin was performed 18 times without any complications. The visual analog scale score (8.1 ± 1.0) and pain frequency (19.4 ± 8.8 times/day) decreased (to 1.9 ± 1.4 and 4.9 ± 5.4 times/day, respectively) significantly (P < .001). After 4 weeks, the mean subjective improvement achieved was 77.5% ± 13.8%, and all patients responded to treatment. CONCLUSION Even without prior experience of sphenopalatine ganglion block, the CAD/CAM-derived guide enabled the accurate and safe administration of botulinum neurotoxin to the sphenopalatine ganglion for the treatment of trigeminal neuralgia.
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Jespersen MS, Jæger PT, Ægidius KL, Meyhoff CS. [ Sphenopalatine ganglion block for treatment of post-dural puncture headache]. Ugeskr Laeger 2019; 181:V12180846. [PMID: 31120017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this review, we discuss transnasal sphenopalatine ganglion (SPG) block: a new, simple and minimally invasive procedure for the treatment of post-dural puncture headache (PDPH) by applying local anaesthesia through the patient's nose to the nasopharynx. PDPH is a severe and disabling complication sometimes caused by lumbar puncture or unintentional dural puncture. Current treatment includes epidural blood patch, which is an invasive and resource-demanding procedure with the potential of causing severe complications such as infection and paralysis. SPG block seems to be effective and may ease and improve the treatment of PDPH.
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Kim NE, Park B, Moon YR, Lee SY, Gil HY, Kim S, Lee S, Chang HS, Jeong HW, Park H, Lee AR, Ahn S, Kim TK, Kim JE, Choi JB. Changes in facial temperature measured by digital infrared thermal imaging in patients after transnasal sphenopalatine ganglion block: Retrospective observational study. Medicine (Baltimore) 2019; 98:e15084. [PMID: 30985662 PMCID: PMC6485901 DOI: 10.1097/md.0000000000015084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Sphenopalatine ganglion block (SPGB) is a technique developed in the 1990s for the management of head and neck pain patients. Recently, transnasal sphenopalatine ganglion block (TN-SPGB) has been widely used for these patients; however, no objective methods exist for validating the success of TN-SPGB. In this study, we measured the changes in facial temperature before and 30 minutes after TN-SPGB by using digital infrared thermal imaging (DITI) to validate its success.The medical records of patients, who underwent TN-SPGB and facial DITI between January 2016 and December 2017, were reviewed. TN-SPGB and facial DITI were performed 36 times in 32 patients. The changes in facial temperatures measured at the forehead (V1), maxillary area (V2), and mandibular area (V3) by using DITI before and 30 minutes after TN-SPGB were recorded and compared. The temperatures on the ipsilateral and contralateral sides of these areas were also compared. The comparison between pain relief group and pain maintenance group was analyzed.After TN-SPGB, the temperature decreased significantly on both sides of V1 (P = .0208, 0.0181). No significant differences were observed between the ipsilateral and contralateral sides (P > .05). There was no correlation between changes in temperature and changes in pain score in the pain regions after the procedure (P > .05).The temperature decreased significantly in V1 area at 30 minutes after TN-SPGB compared with the temperature before TN-SPGB. Based on these results, we propose using DITI to measure temperature changes as an objective method for verifying the success of TN-SPGB.
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Affiliation(s)
- Na Eun Kim
- Department of Anesthesiology and Pain Medicine, Inha University, School of Medicine, Incheon
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon
- Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon
| | - Yeo Rae Moon
- Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
| | - Ho Young Gil
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
| | - Sunok Kim
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
| | - Seryeon Lee
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
| | - Hyuk Soo Chang
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
| | - Hae Won Jeong
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
| | - Hyungbae Park
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
| | - A Ram Lee
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
| | - Soohwan Ahn
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
| | - Tae Kwang Kim
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
| | - Ji Eun Kim
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
| | - Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Ajou University, School of Medicine, Suwon, South Korea
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Abstract
BACKGROUND Septal surgery is a well-established procedure used to treat nasal obstruction due to deviation of the nasal septum, which is carried out under local or general anaesthesia. Local anaesthesia is used for postoperative pain control, but its effectiveness and safety are unclear. OBJECTIVES To assess the effectiveness of perioperative local anaesthesia for reducing pain in septal surgery and to evaluate the risk of associated complications. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Trial Register; Central Register of Controlled Trials; Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 9 January 2018. SELECTION CRITERIA Randomised controlled trials and cluster-randomised controlled trials involving adults or children (or both) who underwent septal surgery. We included studies comparing local anaesthesia versus no treatment/placebo. We also included studies comparing different types of local anaesthesia to each other (i.e. local injection, the addition of an anaesthetic agent to nasal packing, where used, and sphenopalatine ganglion block). DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. The primary outcome was postoperative pain intensity at 12, 24 and 48 hours measured by visual analogue scale (VAS) or another pain outcome tool including numerical or verbal rating scales. Secondary outcomes were requirement for additional analgesia, duration of hospitalisation and adverse effects (postoperative bleeding and postoperative vomiting). We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics. MAIN RESULTS We included seven randomised controlled trials involving 493 participants. In all studies the participants were adults undergoing septoplasty. These studies were heterogeneous and the quality of the body of evidence ranged from low to very low. Few of the studies provided reliable data for the primary outcome in this review.Local anaesthetic injection versus no treatment/placeboTwo studies (142 participants) compared local anaesthetic injection versus placebo but these studies did not report postoperative pain at 12, 24 or 48 hours. It is unclear whether local anaesthetic injection changed the risk of vomiting (odds ratio (OR) 3.10, 95% confidence interval (CI) 0.12 to 79.23; 60 participants; one study) (low-quality evidence). Neither study reported the requirement for additional analgesia, duration of hospitalisation or uncontrollable postoperative bleeding.Local anaesthetic application via nasal packing versus no packing/packing with placeboFour studies (301 participants) used nasal packing postoperatively and compared the addition of local anaesthetic to the pack versus packing with a placebo added. Compared with packing with placebo, the addition of local anaesthetic to nasal packing reduced the pain score on a VAS (ranging from 0 to 100) at 12 hours (mean difference (MD) -16.95, 95% CI -22.27 to -11.62; 151 participants; two studies; I2 = 49%) (low-quality evidence) and at 24 hours postoperatively (MD -7.53, 95% CI -9.76 to -5.29; 268 participants; four studies; I2 = 83%) (very low-quality evidence). These studies did not report postoperative pain at 48 hours. The addition of local anaesthetic to nasal packing decreased the requirement for additional analgesia (OR 0.15, 95% CI 0.07 to 0.34; 151 participants; two studies; I2 = 15%) (moderate-quality evidence). No studies reported duration of hospitalisation, postoperative vomiting or uncontrollable postoperative bleeding.No studies compared the addition of local anaesthetic to nasal packing versus no packing.Sphenopalatine ganglion block versus no treatment/placeboOne study (50 participants) compared sphenopalatine ganglion block versus no treatment but this study did not report postoperative pain, requirement for additional analgesia, duration of hospitalisation, vomiting or uncontrollable postoperative bleeding. AUTHORS' CONCLUSIONS The addition of local anaesthesia to nasal packs (if these are being used) following septal surgery may reduce postoperative pain within the first 12 hours, compared to nasal packing with a placebo added. The effect is uncertain at 24 hours because the quality of the evidence is very low. Evidence was lacking for other outcomes, including adverse effects. There is a lack of evidence about the effects of local anaesthesia added to nasal packing compared to no nasal packing. There is also a lack of evidence about the effects of local anaesthesia given by injection and the effects of sphenopalatine ganglion block.
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Affiliation(s)
- Takashi Fujiwara
- Kurashiki Central HospitalDepartment of Otolaryngology1‐1‐1 MiwaKurashikiOkayamaJapan710‐8602
| | - Akira Kuriyama
- Kurashiki Central HospitalDepartment of General Medicine1‐1‐1 MiwaKurashikiOkayamaJapan710‐8602
| | - Yumi Kato
- Kurashiki Central HospitalCenter of Emergency and Critical CareMiwa 1‐1‐1Kurashiki CityOkayamaJapan
| | - Toshio Fukuoka
- Kurashiki Central HospitalCenter of Emergency and Critical CareMiwa 1‐1‐1Kurashiki CityOkayamaJapan
| | - Erika Ota
- St. Luke's International UniversityGlobal Health Nursing, Graduate School of Nursing Sciences10‐1 Akashi‐choChuo‐KuTokyoJapan104‐0044
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AMSTER JL. Sphenopalatine ganglion block for the relief of painful vascular and muscular spasm with special reference to lumbosacral pain. N Y State J Med 1948; 48:2475-2480. [PMID: 18890612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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