Glossopharyngeal Nerve Block versus Lidocaine Spray to Improve Tolerance in Upper Gastrointestinal Endoscopy

Abstract

Aim of the Study. To compare the effect of glossopharyngeal nerve block with topical anesthesia on the tolerance of patients to upper gastrointestinal endoscopy. Methods. We performed a clinical trial in one hundred patients undergoing upper gastrointestinal endoscopy. Subjects were randomly assigned to one of the following two groups: (1) treatment with bilateral glossopharyngeal nerve block (GFNB) and intravenous midazolam or (2) treatment with topical anesthetic (TASS) and intravenous midazolam. We evaluated sedation, tolerance to the procedure, hemodynamic stability, and adverse symptoms. Results. We studied 46 men and 54 women, from 17 to 78 years of age. The procedure was reported without discomfort in 48 patients (88%) in the GFNB group and 32 (64%) in the TAAS group; 6 patients (12%) in GFNB group and 18 (36%) in TAAS group reported the procedure as little discomfort (χ 2 = 3.95, P = 0.04). There was no difference in frequency of nausea (4% in both groups) and retching, 4% versus 8% for GFNB and TASS group, respectively (P = 0.55). Conclusions. The use of glossopharyngeal nerve block provides greater comfort and tolerance to the patient undergoing upper gastrointestinal endoscopy. It also reduces the need for sedation.

Ultrasound-guided Glossopharyngeal Nerve Block—A New Paradigm in Pain Management

“…GPN block, that is conventionally performed in the peri-styloid region, has been shown to be effective for pain control in such patients. 1 2 3 The feasibility of distal GPN block was first assessed in a cadaveric study conducted by Ažman et al, in which methylene blue injected into the parapharyngeal space under ultrasound-guided injection was confirmed to infiltrate around the GPN on dissection. 5 We could perform distal GPN block successfully performed in all patients under ultrasound guidance and pain relief was obtained in all patients.…”

“…Conventional techniques of GPN block include topical, intraoral and extraoral peri-styloid approaches, out of which the latter two work well for deeper tissue pathologies. 1 2 3 However, both the approaches have a risk of accidental intravascular injection and concurrent blockade of the vagus, spinal accessory, and hypoglossal nerves, all potentially leading to serious complications ranging from hoarseness of voice to life-threatening respiratory difficulty. 2 4…”

A comprehensive review of regional anesthesia for head and neck surgery

“…In a clinical trial by Ortega Ramírez and colleagues, looking at 100 patients undergoing upper GI endoscopy, they compared GPN blocks to topical anesthesia in providing adequate tolerance during the procedure. They concluded that GPN blocks provided greater comfort and reduced the need for sedation as compared with topical anesthesia [48] . Based on multiple evidences, as shown above, neck and airway blocks are effective in reducing pain and discomfort associated with neck surgeries, awake intubation, and endoscopy.…”