Upper Facial Pain Treatment- Home Based Sphenopalatine Block

About eye, forehead, and temple pains from headache source, or surgery can be disabling yet responsive to blocks of the back of nose. The description is laid out in an online article at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545953/

or you can read my version.

Sanghavi, Priti R., Bhavna C. Shah, and Geeta M. Joshi.
Home-based application of sphenopalatine ganglion block for head and neck cancer pain management.
Indian journal of palliative care 23.3 (2017): 282.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545953/

  • Patient needs to be aware will have swab up his nose for 1/2 hour or so –  so bathroom break before hand
  • Local used could affect swallowing so cannot eat or drink until freezing has lost effect.
  • Considered more for people with pain >5/10

Materials –

  • Xylocaine 2% gel or equivalent – this is put inside the nose anteriorly to make putting in of the swab easier. I never understood how important that was until I realized people were not coming back for more than one block…
  • qtips to put topical local in with
  • Sterile Swab – they used a throat swab stick but any would do – mark where 5 cm in is on stick as you don’t want to go further in than that.
  • 3ml syringe with 2 mls of bupivacaine 0.5% drawn up in it – with a short needle on it. (I use lidocaine though that is shorter lasting) –

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Application:

  • With Xylocaine/lidocaine gel on q-tip apply local to turbinates lateral side of nose – upward and backwards up to 5 cm back
  • wait 5 minutes
  • Lay on back
  • insert nose swab – back and up as seen in top picture – in up enough will stop at 5 cm where ganglion is. – if not re-position end further up until gets to a stop.
  • drip 1 ml of local along side of stick slowly
  • Wait 5 minute
  • then “redirected upward, lateral, and backward to cover wide area”
  • drip in 1 more ml of local and hold in for 6-8 minutes

Best to demonstrate to a caretaker.

  • study had 100 Ear-Nose-Throat  cancers
  • “Immediate pain relief was observed by a reduction in VAS score after the procedure, which was reduced from 8.56 ± 1.05 to 2.46 ± 1.23 (P < 0.0001).
  • The mean duration of analgesia was 4.95 ± 3.43 days, (range 1–7 days).”
  • 42 did it weekly; , 25 every 4 days, while 21 did it every other day.
  • about 10% found it difficult to do

Good and Bad Side effects were as one would expect:

  • 4 got faint or dizzy
  • 3 were bothered by throat numbness affecting initial swallowing
  • caused mood elevation (a good side effect)
  • relieved insomnia in all patients
  • “patients were able to swallow without pain which helped in the improvement of food intake.”

Comment – I consider this an important step in pain control. I would like to thank the authors for making this technique available for home use as I am sure it could be helpful there.

 

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