What is the Best Method of Delivering A (SPG) Sphenopalatine Ganglion Block

SPG Blocks have a hundred year history of safety and efficacy. There are multiple methods of administering these blocks.

My practice is unusual because I utilize all of the described methods discussed in this article. I have been utilizing the blocks since 1986 and been teaching self administration of SPG Blocks for over 30 years.  I have a paper being published in Cranio Journal: The Journal of CranioMandibular and Sleep Practice in May, 2019 on Sphenopalatine Ganglion Blocks and Neuromodulation.  My next two scheduled lectures are at ICCMO meetings in Moscow in May and Kansas City in September.  I may be doing a lecture in Aruba this summer as well.

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Injection therapy is the most direct approach. Injection can be done intra-orally via the Greater Palatine Foramen. This approach is usually the treatment of choice for dentists and many ENT’s.

The Suprazygomatic injection is also excellent but many general dentists are not comfortable with the procedure.

Some medical professionals chose to use fluoroscopy to deliver SPG Blocks but this is time consuming, expensive, has radiation exposure and is unlikely to improve on final results.

The Trans-nasal approach is also very popular particularly with neurologists who are not comfortable with the above injection approaches.

The are currently 3 devices designed to deliver anesthetic to the area of the Sphenopalatine Ganglion, the Allevio, the TX360 and the Sphenocath. These devices are all high tech “suirt guns” that deliver anesthetic to the nasal mucosa overlying the pterygopalatine fossa that houses the Sphenopalatine Ganglion.

It is also possible to use nasal swabs to deliver anesthetic to the ganglion but a far superior method it the use of continuous capillary feed of anesthetic by cotton-tipped nasal catheters.

Self-administration or Patient-Administration with cotton-tipped nasal catheters is very easy for the majority of patients to learn. More important, is that it increases the time that the anesthetic stays in contact with the mucosal over the ganglion. Patients are mobile and can watch TV, work on computer, read books or newspapers while administering the blocks.

Self-Administered SPG Blocks are safe and can be effective for even very severe, intractable pain of cancer.

The use of repeated blocks at three times a day was reported in this article:

Reg Anesth. 1996 Jan-Feb;21(1):68-70.
Patient-administered sphenopalatine ganglion block.
Saade E1, Paige GB.
Author information
Abstract
BACKGROUND AND OBJECTIVES:
Pain resulting from head and neck cancer can be severe and difficult to manage. Avoiding hospitalization for as long as possible with a reasonable level of comfort requires a number of therapeutic modalities. The usefulness of self-administered sphenopalatine ganglion block was evaluated in a patient with lethal midline granuloma requiring large doses of morphine.

METHODS:
A 30-year-old woman with intractable pain from lethal midline granuloma was taught to self-administer 4% lidocaine, 1.5 mL topically into each nostril three times per day.

RESULTS:
A 3-month follow-up examination showed substantial pain relief and reduction in morphine requirement. No adverse side effects or complications developed.

CONCLUSIONS:
In certain patients, sphenopalatine ganglion block can be effectively self-administered a

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