To perform a sphenopalatine ganglion block, first use a nasal mucosal atomizer with 1-2 ml of liquid lidocaine to anesthetize the nare(s). Next, soak a cotton-tipped applicator in topical anesthetic (e.g. 2% lidocaine), and introduce the applicator under the middle turbinate (horizontally) until you touch the posterior nasopharynx. Leave the applicator in place for 10 minutes before removing. You can perform the procedure unilaterally or bilaterally depending on the distribution of the headache.
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Kenneth D. - January 5, 2021 1:47 PM
Cool technique. Does it matter which side or do you do both sides?
Jess Mason - January 11, 2021 9:13 AM
I treat the side of the headache. You can do both sides.
John C. - January 8, 2021 9:09 AM
There are many ways to do this block.
Yours is not bad, but mine is a lot better.
Check it out at the link below
https://youtu.be/OzfChYro1ZQ
Yan Y. - January 12, 2021 11:15 AM
Hi John, Thanks for the link. I note your method requires significantly more equipment, setup time, and procedure time. Would be interesting to study if one method produces a significantly better result.
John C. - January 14, 2021 4:35 PM
Dr. Yan,
In the demo, they did one side. I usually do it bilaterally although I have done only one side with good results.
My setup involves one 3 cc syringe, 2 needles, and 2 6-inch cotton-tipped applicators at a total cost of under one dollar. It takes me less than 2 minutes to set up for the procedure.
The 2-minute intervals between instilling the local anesthetic does add a bit of practitioner time but this could be done by an assistant if you are very busy. If you had an assistant do that you could reduce practitioner time to about 5 minutes, otherwise its about 10 minutes in total.
The method I utilize uses less anesthetic and holds a greater portion of the anesthetic on the ganglion. I started doing the block this way when I had patients who got partial relief with the first squirt and I found doing it again often helped.
I too would be interested in a study and would be happy to participate, but I have neither the resources or the expertise to initiate one on my own.
Josiah H. - February 22, 2022 9:08 AM
Watched your video and I like your approach, but it makes me a bit nervous to have the shaft of the cotton-tip applicator be the only protection from the needle in the patient's nose. I'd be much more on board if it were a blunt tip or simple angiocath.
John C. - February 23, 2022 5:17 PM
Josiah,
When | was in the Emergency department, I would use 20 gauge cathelons. I tried 18 Gauge blunts but found them too hard to get into the shaft of the applicator.
John