The duration of action will vary with both the method of delivery, the anesthetic utilized and characteristics of the individual patients.
The new tran-snasal catheter delivery devices all deposit anesthetic over the mucosa covering the pterygopalatine fossa. The three devices are the Sphenocath, the Allevio and the TX360 used in the MiRx protocol.
All three of these devices are basically medical squirt guns that deliver liquid anesthetic which passes thru tissues and into the ganglion. The correct positioning and delivery is important with these devices, but it is also important how the the patient remains supine (on their back) after delivery. Ideally a minimum of ten to twent minutes is best.
I routinely utilize lidocaine2% because of safety and extremely low toxicity as well as the fact that lidocaine has anti-inflammatory effects. Other types of anesthetic include mepivicaine, Bupivacaine Hydrochloride (marcaine) and articaine. These can be done with or without vasoconstrictors which help the anesthesia last longer. If pepeated anesthetic relieve all or most of the pain on multiple occasions an alcoholblock will last for 3-6 months.
An important factor is the frequency of Sphenopalatine ganglion blocks. Typically there is two weeks between applications of anesthetic with all three devices.
Injection techniques tend to give more extended relief which can be increased by using longer lasting anesthetics. It is possible to utilize an intra-oral injection through the Greater Palatine Foramen, a procedure that dentists and ENT’s are trained and comfortable with oral injections. In general dentists are more gently in giving these injections than any other medical professional.
Extra-oral injections can be done with radiographic guidance though it is rarely needed for delivery of anesthetic. The suprazygomatic approach is very easy to preform without radiographic guidance and is actually far easier than a mandibular trigeminal block that dentists do on a daily basis. Injection techniques should be tried on patient who do not respond to topical nasal application before giving up on SPG Blocks.
How long does an SPG Block last? The more times the block is repeated success is seen to improve with repetitive use.
To really extend the duration of pain relief the best approach is to treat all patients to self-administer SPG Blocks on a regular basis. My patients typically begin doing the blocks twice a day initially.
Self-administration on a daily or twice daily basis will give the longest acting relief. More important to patients is that they can do it as often as necessary to maintain a high quality of life.
Quality of life improves with pain relief but self administration has another important aspect, it gives the patient control of their pain. Relief is usually almost instananeous or within seconds to minutes.
SPG Blocks are not only used to treat chronic headaches, migraines and TMJ disorders but also problems like depression, anxiety, and stress reactions. Patients who self-administer with cotton-tipped nasal catheters can easily do blocks two or more times daily without having their lives disrupted by trips to physician or emergency rooms. Self administration offers continual capillary feed of anesthetic to the area of the sphenopalatine ganglion keeping a high continuous level of anesthesia.
My personal experience is that patients need SPG Blocks less over time when doing self-administration. Because they are so easy to do and minimally expensive there are no barriers to using them as frequently as needed. This is very comforting to patients who when relieved of pain and the stress of knowing they will be in pain again begin to feel safe and secure. The fact that costs of doing a self -administered block is less than $1.00 per application it becomes affordable for patients without insurance or who do not receive coverage. They can utilize these blocks as often as needed without financial strain. The initial appointments are the only financiacial burder but typically the cost for a consultation, exam, initial block and supplies for 100 self-administered block is about $1250 dollar total. Additional supplies are less than $100 for an additonal 100 bilateral blocks, or less than $1.00 per block.
The real savings are due to emergency room and physician visits that are no longer needed. The ability to control pain and avoid needless suffering is priceless.
How long does a Sphenopalatine Ganglion Block Last?
Hours to days and sometimes weeks. Alcohol injections can last months. Learning to self-administer when successful is basically means it lasts a lifetime. This is much like the story “Buy a man a fish and he eats for a day but teach him to fish and he will never be hungry again.
The Sphenopalatine Ganglion Block addresses both the Somatosensorey and the autonomic nervous systems. Generally it turns down autonomic sympathetic activity and increases parasympathetic activity. The sympathetic nerves feed the “Fight or Flight reflex” while the Parasympathetic system controls the “Feed and Breed reflex” or “eat and digest reflex”. These parasympathetic feelings are similar to how we feel playing with babies, puppies and kittens or falling in love.
Very effective for turning off stress reactions and PTSD.
Do SPG Blocks cure pain? Yes, for some people but they are excellent at controlling and eliminating pain.
Neuromuscular diagnostic orthotics are extremely effective at controlling and eliminating pain related to TMJ disorders. This is partially due to the use of the Myomonitor which has an amazing 50 year safety record in stimulating the trigeminal and facial nerves to relax muscles and reduce myofascial pain and nociceptin into the trigeminal nervous system Almost 100% of all headaches are controlled by the trigeminal nervous system
The Myomonitor also acts as a Sphenopalatine Ganglion Stimulator. The BNS 40 is a smaller Myomonitor for patient home use. While it is FDA approved for specific uses related to TMJ disorders it can drastically reduce and eliminate a wide variety of chronic headaches and migraines on its own but is best used inconjuction with neuromuscular orthotics.