A Morphometric Study of the Sphenopalatine Foramen and its Clinical Implication in Transnasal Sphenopalatine Ganglion Block

Sir, Ender

doi:10.5222/mmj.2019.20586

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…For the transnasal approach, the use of a rigid applicator, such as a cotton swab, improves the efficiency of the block; in some studies, using the cotton swab to apply the local anesthetic has given better results than using an intranasal spray, with 12%-47% more efficacy. 23,34,35 Most adverse events related to SPGB are transient epistaxis and a bitter taste in the mouth. There have been some reported cases of oropharyngeal numbness, ipsilateral nostril and eye burning sensation, nasal discomfort, diplopia, and reduced buccal opening.…”

Section: Discussionmentioning

confidence: 99%

“…To reach the SPG, the surgeon sets the inclination of the cotton swabs with an angle of 25° from the palatum durum and passes between the middle and superior nasal turbinates through a superolateral direction, maintaining contact with the lateral wall. 23 Finally, the cotton swab is removed and the Mayfield skull clamp is placed (Fig. 2).…”

Section: Transnasal Spgb Proceduresmentioning

confidence: 99%

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Effects of a sphenopalatine ganglion block on postcraniotomy pain management: a randomized, double-blind, clinical trial

Mantovani,

Sgarbanti,

Indaimo

et al. 2023

Neurosurgical Focus

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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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Section: Discussionmentioning

confidence: 99%

Section: Transnasal Spgb Proceduresmentioning

confidence: 99%

Effects of a sphenopalatine ganglion block on postcraniotomy pain management: a randomized, double-blind, clinical trial

Mantovani,

Sgarbanti,

Indaimo

et al. 2023

Neurosurgical Focus

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“…Применение регионарных блокад с целью анальгезии широко используется во всех областях медицины, особый интерес представляет блокада крылонебного узла, который имеет сложное строение за счет сочетания компонентов как чувствительной, так и вегетативной иннервации, что обосновало ее применение с целью купирования болевого синдрома различного генеза. Существуют разные доступы к крылонебному узлу: интраназальный [1], над-и подскуловой [2]. На сегодня крылонебная блокада (КНБ) часто используется как компонент анальгезии в лор-хирургии [3], а также в офтальмохирургии [4].…”

Section: Introductionunclassified

The Analgetic Efficacy of Pterygopalatine Blockade for Pain Treatment in Adults: a Systematic Review and Meta-Analysis

Oleshchenko

Юрьева

Заболотский

2023

Kuban. nauсh. med. vestnik

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Background. The use of regional blockades for the purpose of analgesia is widely used in all fields of medicine, however, the analgesic efficacy of the pterygopalatine blockade, as an independent method of treating pain of various genesis, has not been studied enough. Therefore, there is a need to analyze the results of clinical trials to evaluate the analgesic efficacy of the pterygopalatine blockade as an independent method of anesthesia.Objective — to investigate the analgesic effect of pterygopalatine blockade as a monotherapy in patients with pain of various origins of oculotemporal area, conducting a meta-analysis of published results of randomized clinical trials.Methods. The methodology involved a systematic literature search by means of PubMed, MEDLINE, EMBASE, and Cochrane Library search engines. The search covered the period of the past 10 years and had the following criteria: a double-blind, randomized, controlled study of the use of pterygopalatine blockade with a local anesthetic versus placebo. For each included study, a standardized magnitude of the analgesic effect of pterygopalatine blockade compared to placebo was calculated, with pain assessing in 15, 30, and 60 minutes after the blockade was performed. Meta-analyses were conducted for each endpoint. Meta-analysis was performed using Stata 11.0 application programs ((The Cochrane Collaboration, Oxford, United Kingdom).Results. Five randomized controlled trials involving 269 patients met the inclusion criteria, and involved analyzing the pterygopalatine blockade with local anesthetic (n=140) against placebo (n=129). In 15 minutes after pterygopalatine blockade was performed, the difference in mean pain intensity compared to the control group was -2.5 points, the mean level was lower in the pterygopalatine blockade group, MD=-2.5 [95% CI -3.7; -1.7]. After 30 minutes: -2.7 points, MD=-2.7 [95% CI -4.5; -1.5], after 60 minutes: -1.7 points, MD=-1.7 [95% CI -4.0; -0.5]. The relative risk of adverse effects, such as nasopharyngeal symptoms, after performing a pterygopalatine blockade with a local anesthetic accounted for (RR =1.31 [95% CI 0.5–3.04]). In this regard, the incidence of complications and their variants that can be caused by pterygopalatine blockade is a matter for further clinical research.Conclusion. The results obtained in the meta-analysis testify to the analgesic effect of the pterygopalatine blockade as a monotherapy in patients with pain of different origins oculotemporal area in 15, 30, and 60 minutes after its performance. These data may be relevant when choosing a method for first-line anesthetic management of pain syndrome of oculotemporal area.

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Morphometric analysis of sphenopalatine foramen on computed tomography images with clinical significance

et al. 2022

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A Morphometric Study of the Sphenopalatine Foramen and its Clinical Implication in Transnasal Sphenopalatine Ganglion Block

Cited by 5 publications

References 19 publications

Effects of a sphenopalatine ganglion block on postcraniotomy pain management: a randomized, double-blind, clinical trial

Effects of a sphenopalatine ganglion block on postcraniotomy pain management: a randomized, double-blind, clinical trial

The Analgetic Efficacy of Pterygopalatine Blockade for Pain Treatment in Adults: a Systematic Review and Meta-Analysis

Morphometric analysis of sphenopalatine foramen on computed tomography images with clinical significance

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