Sphenopalatine Ganglion Block
Indication: Headache and Facial Pain
The sphenopalatine ganglion is a small triangular structure located in the pterygopalatine fossa, posterior to the middle turbinate and inferior to the maxillary nerve. It is covered by a thin layer, about 1 to 5 mm, of connective tissue and mucous membrane. Anesthetization of the sphenopalatine ganglion is accomplished via the transnasal approach. The patient is placed supine on the treatment table with the nose pointed at the ceiling. A cotton applicator soaked with 2% to 4% lidocaine is inserted into the nose on the side of headache.
To avoid mechanical discomfort, the cotton applicator should be inserted deeply into the upper posterior wall of the nasopharynx. A slow drip of 2-4 ml of lidocaine over a 2 to 4 min period into the nose through the cotton applicator often achieves the goal of a sphenopalatine ganglion block with the local anesthetic flowing down to the back of nasopharynx by gravity. Sphenopalatine ganglion blocks have been reported to be effective in the relief of a wide variety of pain conditions of the head including acute migraine attacks, cluster headache, atypical facial pain, and head and facial RSD. The procedure is easy to perform in the clinic and may be helpful for neurologists without special training in interventional pain management to treat an acute headache attack.