Sphenopalatine Ganglion Block
What is a sphenopalatine ganglion block?
A sphenopalatine ganglion block is a short, minimally-invasive procedure that is effective at treating some acute and chronic facial and head pain.
How sphenopalatine ganglion block works
There are many approaches your physician can use to perform the sphenopalatine ganglion block, including the transnasal, transoral, and lateral approach.
The transnasal approach
The transnasal approach is the simplest and most common technique among the three. During this procedure, you will be asked to lie down on your back and extend your neck into a sniffing position. Your physician will inspect your anterior nares for any visible polyps, tumors, or significant septal deviation before beginning. A small amount of 2% viscous lidocaine is instilled into the nare(s) being treated, after which you will be asked to briskly inhale. This draws the local anesthetic toward the posterior nasopharynx, lubricating it and anesthetizing it in the process, while making the procedure more comfortable for the patient.
Topical sphenopalatine ganglion block
If your physician decides to perform the sphenopalatine ganglion block topically, he or she will introduce a sterile 10-cm cotton tipped applicator dipped in the chosen anesthetic and slowly advance it along your superior border of the middle turbinate until it reaches the posterior wall of the nasopharynx. The applicator is usually left in place for approximately 20-30 minutes.
Sphenopalatine ganglion block via injection
If your physician decides to perform the sphenopalatine ganglion block via injection, your physician will anesthetize part of your cheek. Next, he or she will advance a small needle under X-ray guidance through anesthetized tissue. Your physician will carefully advance the needle to the correct location, after which he or she will confirm correct positioning under fluoroscopy before injecting the anesthetic.
No matter whether placed topically or via injection, a successful block is marked by profound pain relief. For patients who have a documented response to administration of local anesthetic onto the sphenopalatine ganglion, you and your physician may decide upon performing neurolysis or radioablation of the sphenopalatine ganglion for a longer duration of pain and symptom relief.
Depending on whether your physician performs this block topically or via injection, this procedure may take anywhere from 15 minutes to 30 minutes at most. Sometimes your physician will recommend intravenous sedation to make the procedure more comfortable. Your physician will monitor your pain and vital signs (pulse, blood pressure) after the procedure.
Are there risks?
The risk of this procedure is very low. The most common side effects of this procedure include developing a bitter taste in your mouth from the local anesthetic potentially dripping down from the nasopharynx down into your oropharynx or developing a slight numbness in the back of the throat from the local anesthetic dripping down into your throat.
Occasionally, some patients may develop epistaxis (nose bleed) from your physician accidentally abrading your internal nare anatomy from placing of the block. Some patients may also experience slight lightheadedness that usually resolves after 20-30 minutes after the procedure. With any procedure that involves local anesthetic, there is a theoretical risk of drug allergy and seizure (if the medication is injected into a blood vessel). Lastly, with any penetration of the skin and soft tissues, the risk of infection always exists.