Lidocaine Versus Bupivacaine in the Treatment of Headache with Intranasal Sphenopalatine Nerve Block

Abstract

Background: Intranasal sphenopalatine ganglion (SPG) block has been shown to be an effective treatment for headaches. Multiple therapeutic agents have been studied, although the wide availability and low cost of lidocaine and bupivacaine have made them attractive treatment options. To the authors knowledge, no study has yet demonstrated superiority of one anesthetic over the other. Objective: To determine the efficacy of lidocaine versus bupivacaine when performing intranasal sphenopalatine ganglion (SPG) block for the treatment of headaches. Study Design: Retrospective cohort study. Setting: A single tertiary care academic institution Methods: This retrospective study identified patients who underwent SPG block at a single institution from January 1, 2014 to December 20, 2017. Patients were included if they were treated with either lidocaine or bupivacaine and had both pre- and post-procedure pain scores recorded on a 0-10 scale. Patients were excluded if they were less than 18 years of age. Results: 386 total procedures were performed. 303 (78.5%) were lidocaine delivered via the SphenoCath device, and 83 (21.5%) were bupivacaine delivered via the Tx360 device. 90.2% of treatments (n = 348) decreased the patient’s pain level. Of the treatments performed with lidocaine, 89.1% (n = 270) resulted in improvement of the patient’s pain level with a mean decrease in pain level of 3.1 (SD ± 2.3). Of the treatments performed with bupivacaine, 94.0% (n = 78) resulted in improvement of the patient’s pain level, with a mean decrease in pain level of 3.0 (SD ± 1.9). No statistically significant difference was found between the 2 anesthetics. Limitations: The retrospective study design may introduce selection bias. Both lidocaine and bupivacaine were administered by different devices (Sphenocath and Tx360 respectively) which may account for differences in initial treatment success. There were differences in the size of the two groups, which may also introduce error. Conclusions: This study demonstrates similar efficacy of SPG block performed with lidocaine or bupivacaine. While no difference was found, the particular advantages and disadvantages of the intranasal delivery device may influence physician choice. Key words: Sphenopalatine ganglion nerve block, lidocaine, bupivacaine, sphenocath, Tx360, pain intervetnio, headache, miimally invasive therapy

Transnasal Sphenopalatine Ganglion Block for the Preventive Treatment of Chronic Daily Headache in Adolescents

“…There are few headto-head studies comparing the efficacy of different medications, and the existing findings fail to demonstrate a superior agent. A retrospective study evaluating 386 SPG blocks for headache found no difference between bupivacaine and lidocaine for pain reduction [21]. A randomized controlled study of 90 patients compared SPG block with lidocaine 2%, lidocaine 5%, and bupivacaine 0.5% for treating post-dural puncture headache and again found no difference between the groups [22].…”

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

“…д.) [21,22] или же другой местный анестетик [23]. Оставшиеся 5 исследований [8][9][10][11][12], которые соответствовали критериям включения и исключения, составили основу данного метаанализа.…”

“…Юрьева, Д.В. Заболотский Эффективность применения крылонебной блокады с целью обезболивания у взрослых: систематический обзор и метаанализ В нашем исследовании отсутствие плацебо в группах сравнения или сочетание КНБ с другим периферическим блоком в некоторых исследованиях сделало невозможным включение их в метаанализ и статистическую обработку [15,[21][22][23]38]. Тем не менее хотелось бы остановиться на результатах данных публикаций подробнее.…”

“…D. L. Kirkpatrick и соавт. (2020) изучили эффективность лидокаина по сравнению с бупивакаином при выполнении КНБ для лечения головных болей [23]. Из процедур, проведенных с лидокаином, 89,1% (n = 270) привели к снижению среднего уровня боли на 3,1 (SD ±2,3).…”