This new article on Sphenopalatine Ganglion Blocks (SPGB) focuses on the use of SPG Blocks to prevent vomiting and nausea after endoscopic sinus surgery.  A more important question was left unaddressed will this work for vomiting and nausea related to chemotherapy or other disorders.  This could make a significant improvement in the life of patients going thru cancer treatment.  It should also be noted that it also reduced the number of vomiting episodes.  Frequent vomiting is extremely upsetting to patients who have recently had surgery, especially abdominal surgery.  An excellent study would be to evaluate the use of Sphenopalatine Ganglion Blocks (SPBG) a preventive for any surgery requiring general anesthetic.  The risk of aspirating vomit is substantial and if a simple SPG block could lower the risk it may be worthwhile to make SP_G Blocks a universal precaution for any surgery.

What if the “Miracle” blocks relieve nausea and vomiting relating to stomach flu or nausea and vomiting related to  general anesthetic.

It is interesting to note that this study looked at post operative nausea related to surgery for chronic rhinosinusitis.  It turns out that chronic vaso-rhinosinusitis is a condition that can be treated or relieved with SPG Blocks.

It is definitively worthwhile knowing that it is effective following sinus surgery because it is so easy for ENT’s to do this procedure while doing sinus procedures.

The most common uses of SPG block is to treat or prevent headaches, migraines, cluster headaches, sinus pain, sinus headaches, TMJ disorders, TMD and Autonomic Cephalgias.

The abstract  on vomiting is below but this is a series of  emails on a patient from England after he came in for SPG Blocks and a “quick and dirty neuromuscular appliance ”


This is a patient who traveled to the US to see me to learn to Self-Administer SPG Blocks.

He is also interested in Having a DNA Appliance to grow his airway larger via orthopedics and pneumopedics.

In addition to the SPG Blocks we discussed his long term bite issues and created an appliance from one of his old orthotics that did not help and did a “quick and dirty” neuromuscular bite.

E-MAIL   Dec 16th 10:01 AM

Hi! Thanks for yesterday…..

Something has happened as after getting off the place this morning later today I went down to the gym followed by a run outside. This is not the norm usually I can’t leave the sofa after all that travel etc. Maybe the blocks?!

With the bite, I’m getting a tight neck though. There is pain going into the left side mostly, I feel really balanced but I’m not sure I will be able to keep it in soon as something doesn’t feel right with the neck (also the front lingual is bashing my tongue, I have been with my lab tech here to see if he can come up with a solution). Could the neck stiffness/tightness be the bite is not forward enough or anterior missing? I know it was a quick bite you gave me so I understand it was done fast

Overall I was impressed by how you could help me, I like you have the AO next door and can make the orthotics yourself. I’d like to talk to you about how you could possibly help me, your experience in this field is supreme!


Dr Shapira response:
You did not have a straight posture, you were lopsided at the pelvic floor from functional long leg short leg that corrected with Aqualizer. you has A/O supported with neuromuscular orthotic.  Not sure what else Dr Freund did.
SPG Block resets autonomics.  don’t wait to do again.
It is all of it.

E-Mail Dec 16th 5;24 PM

Something else has happened which is pretty amazing, my pelvic floor is activating again and switching on. Do you remember me telling you about my stomach issue, well today so much wind and come through me and my bloating has gone down. I don’t know if its the SG block or the straight posture. Although I has straight posture before and had bad stomach so that indicates its the blocks. This is very exciting, I’ve never been able to find a answer for this.

I would like to speak this week and discuss a plan and strategy as it complicated as I am due to get the DNA Appliance

Dr Shapira Response:        I would normally do the first adjustment about 4 hours after delivering the appliance and see you again the next morning.  Did not schedule for starting case just quick dirty bite.  Energy probably still orthotic related.  Neck pain because of catch up.  Go up and down steps with Aqualizer.  Did we teach you spray and stretch to turn off muscle pain?

You can use TENS on neck if you are interested we can discuss.


Am J Rhinol Allergy. 2018 Jan 1:1945892418782235. doi: 10.1177/1945892418782235. [Epub ahead of print]

The Role of Endoscopic Sphenopalatine Ganglion Block on Nausea and Vomiting After Sinus Surgery.


Background Postoperative nausea and vomiting (PONV) are among the most common unpleasant and distressing adverse events following surgery under general anesthesia. Functional endoscopic sinus surgery (FESS) is a common otolaryngology procedure. Prevention of PONV and early recovery are cost-effective. Objective The aim of this study was to evaluate the prophylactic effect of bilateral endoscopic injection of lidocaine with epinephrine in the sphenopalatine ganglion (SPG) on PONV in patients undergoing FESS. Methods One hundred patients with chronic rhinosinusitis undergoing general anesthesia for FESS were enrolled in this double-blind, placebo-controlled study. Patients were randomized to receive injection of 2 mL of 2% lidocaine with epinephrine or 2 mL of saline at the end of surgery. Postoperatively, patients were observed for 24 h. PONV was evaluated immediately, 6 h, and 24 h after surgery. Results The 2 groups were comparable in characteristic and intraoperative features. In general, the incidence of PONV after FESS was 36%. The average time that patients can tolerate oral feeding was 3.4 h after surgery. Endoscopic SPG injection with lidocaine significantly reduced the incidence of vomiting and PONV. In addition, SPG injection with lidocaine reduced the incidence of severe vomiting and decreased the number of vomiting episodes. No complications were encountered in either group. Conclusion SPG injection with lidocaine at the end of surgery is a safe, noninvasive, and an effective technique in reducing early PONV in endoscopic sinus surgery patients.


complications; functional endoscopic sinus surgery; incidence; lidocaine; nausea; sphenopalatine ganglion block; vomiting

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