Next Level Techniques: the Sphenopalantine Ganglion Block
The sphenopalantine ganglion, located posterior to the middle turbinate, is composed of parasympathetic fibers. When stimulated, it causes neurogenic inflammation and the activation of the trigeminal nociceptors causing pain and headache. Headache relief can be achieved by providing a nerve blockade and shutting down these signals.
To perform the block, you will need a long cotton swab, a medicine cup, 1% lidocaine and 0.5% bupivacaine:
1) Mix a 1:1 ratio of lidocaine:bupivacaine in the medicine cup. This will help to achieve both rapid and long-term relief.
2) Soak the cotton swab in the medicine cup.
3) Lay the patient in a supine position with a chin lift position.
4) Insert the cotton swab through the nostril and advance by following the middle turbinate to the posterior mucosa. Perform bilaterally.
5) Let sit for 5-10 minutes as the patient relaxes.
6) Remove the cotton swabs.
The randomized studies that exist have shown over half of patients will report a greater than 50% reduction in pain.
Most common side effects to warn patients about are mild discomfort during the procedure and a bitter taste at the back of the throat.
Cline, David M. Tintinalli’s Emergency Medicine: Just The Facts. New York: McGraw-Hill Medical, 2013. 494-495.
Robbins MS, et al. The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache. Headache. 2016; 56(2): 240-258
Schaffer, J; et al. Noninvasive sphenopalatine ganglion block for acute headache in the emergency department: a randomized placebo-controlled trial. Annals of Emergency Medicine. 2015; 65(5):503-510.
Maizels M, et al. Intranasal lidocaine for treatment of migraine: a randomized, double-blind, controlled trial. JAMA. 1996; 276(4):319-321.