Transnasal Sphenopalatine Ganglion Block

Aka: Transnasal Sphenopalatine Ganglion Block, Sphenopalatine Ganglion Block, Sphenopalatine Nerve Block

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II. Indications

  1. Emergency Department Migraine Headache Care

III. Contraindications

  1. Altered Mental Status
  2. Acute Head Trauma
  3. Bleeding Disorder or Anticoagulation (risk for difficult to control Epistaxis)

IV. Background

  1. Sphenopalatine Ganglion Block may be performed from several routes (oral, nasal, infratemporal)
  2. This approach is for a non-invasive transnasal approach

V. Preparation

  1. Soak a long cotton applicator (long Q-Tip) in Topical Anesthetic
    1. Lidocaine 1-4% or
    2. Bupivicaine 0.5%

VI. Technique

  1. Patient lies with head elevated and with head in a sniffing position
  2. Insert the cotton swab (soaked with Topical Anesthetic) gently in the ipsilateral nare (side of the Headache)
    1. Continue to gently slide the swab along the nasal floor until it meets resistance
  3. Leave the swab in place for 5-10 minutes
  4. Remove the swab at no more than 10 minutes, and re-evaluate the patient

VII. Resources

  1. Sphenopalatine Ganglion Block for Treatment of Primary Headaches (ALiEM; Shih, MD)
    1. https://www.aliem.com/2017/03/trick-sphenopalatine-ganglion-block-primary-headaches/

VIII. References

  1. Lin (2017) EM:Rap 17(11): 9-10

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