Review
Methods
Protocol
Information sources
Literature search strategy
Eligibility criteria and study selection
Data items and collection
Risk of bias assessment
Analysis of evidence and recommendations
Results
Overall summary
Medical condition | Application/ Medication used in controlled studies | Number of controlled studies | Highest level of evidence | Grade of recommendation |
---|---|---|---|---|
SPG block | ||||
Cluster headache | Cotton swab/cocaine or lidocaine | 1 | 2b | B |
Second-division trigeminal neuralgia | Lidocaine spray | 1 | 2b | B |
Reducing the needs of analgesics after endoscopic sinus surgery | Needle injection, transnasal and palatal approach/lidocaine,bupivacaine, levobupivacaine, tetracaine | 6 | 1b | B |
Reducing the pain associated with nasal packing removal after nasal operation | Needle injection, infrazygomatic approach/lidocaine | 1 | 3b | B |
Migraine | Tx360 device/ bupivicane | 1 | 2b | B |
Postdural puncture headache, sphenopalatine maxillary neuralgia, facial neuralgia, sympathetic neuralgia, post-traumatic atypical facial pain, atypical odontalgia, pain from midline granuloma, herpetic keratitis, hemifacial headache,paroxysmal hemicrania, nasal pain, hemicrania continua, trigeminal neuropathy, cancer pain, seizures associated nasal pathology, arthritic pain and muscle spasm, intercostal neuritis, persistent hiccups, ureteral colic, dysmenorrhea, peripheral painful vascular spasm, complex regional pain syndrome and hypertension | Various protocols | 0 | 4 | C |
Myofascial pain | Cotton-tipped applicator, nasal spray/lidocaine | 2 | 2b | Not recommended |
SPG radiofrequency ablation | ||||
Cluster headache | Infrazygomatic approach/80 °C, 60s ×2 | 0 (1 cohort study) | 2b | B |
Sluder’s neuralgia, posttraumatic headache, chronic head and face pain, atypical trigeminal neuralgia, atypical facial pain, chronic facial pain secondary to cavernous sinus meningioma, trigeminal neuralgia, SPG neuralgia due to herpes zoster | Various protocols | 0 | 4 | C |
SPG neurostimulation | ||||
Cluster headache | Customized to each patient, mean frequency 120.4 ± 15.5 Hz, pulse width 389.7 ± 75.4 μs, intensity 1.6 ± 0.8 mA | 1 | 1b | B |
Idiopathic facial pain, migraine | Various protocols | 0 | 4 | C |
Evidence level above case series | ||||||||
---|---|---|---|---|---|---|---|---|
Author | Year | Medical problems | Approach | Imaging | Medication | Number of cases | Study design | Outcome |
SPG Block | ||||||||
Berger et al. [32] | 1986 | Low back pain | Cotton tip applicator and transnasal needle | None | Cocaine or lidocaine | 7 cases with cocaine, 7 cases with lidocaine, 7 controls | Case-control | No statistical significance between cases and controls |
Slade et al. [51] | 1986 | Tear secretion with topical anesthesia | Needle injection, through the greater palatine foramen | None | 2% lidocaine | 10 | Case-control (using self as control) | Tear secretion significantly reduced by 73% (p < 0.001) |
Henneberger et al. [36] | 1988 | Nicotine addiction | Cotton tipped applicator, transnasal approach | None | Bupivacaine, cocaine or saline | 6 with bupivacaine, 5 with cocaine, 6 with saline | Double-blind placebo-controlled | Significantly fewer symptoms of discomfort for patients in the anesthetic treatment groups than placebo group |
Silverman et al. [37] | 1993 | Experimentally induced pain (submaximal effort tourniquet test) | Cotton tipped applicator | None | 20% lidocaine and epinephrine | 16 healthy volunteers | Double-blind, cross-over study | No significant difference between experimental and placebo group. |
Scudds et al. [3] | 1995 | Chronic muscle pain syndrome | Cotton tipped applicator, transnasal approach | None | 4% lidocaine | 42 with fibromyalgia, 19 with myofascial pain syndrome | Double-blind randomized controlled | No statistical significance between 4% lidocaine and placebo |
Janzen et al. [30] | 1997 | Myofascial pain syndrome and fibromyalgia | Nasal spray | None | 4% lidocaine | 42 with fibromyalgia, 19 with myofascial pain syndrome | Double-blind, placebo-controlled | No statistical significance between 4% lidocaine and placebo |
Ferrante et al. [31] | 1998 | Myofascial pain syndrome of the head, neck and shoulders | NA | None | 4% lidocaine | 13 cases, 7 controls | Double-blind, placebo-controlled, crossover design | No statistical significance |
Costa et al. [6] | 2000 | Cluster headache (nitroglycerin induced) | Cotton tipped applicator, transnasal approach | None | 10% cocaine or 10% lidocaine | 6 episodic CH, 9 chronic CH | Double-blind, placebo-controlled, | All patients with induced pain responded to cocaine after 31.3 min and lidocaine after 37 min |
Hwang et al. [23] | 2003 | Removal of nasal packing after nasal operation | Needle injection into the greater palatine canal | None | 1% lidocaine | 11 | Case-control | Injection side had significantly lower pain than the control side |
Kanai et al. [11] | 2006 | Second division trigeminal neuralgia | Nasal spray | None | Lidocaine | 25 | Randomized control | Significantly decreased pain with intranasal lidocaine spray |
Ahmed et al. [18] | 2007 | Sinonasal surgery intraoperative isofluorane consumption, hypotensive agents used, postoperative pain | Bilateral SPG block, injected between the middle and inferior turbinates | None | 0.5% lidocaine and epinephrine. | 15 cases, 15 controls | Randomized-controlled | Significantly reduced intraoperative isofluorane consumption and esmolol use, postoperative tramadol use and postoperative pain. |
Ali et al. [20] | 2010 | Endoscopic trans-nasal resection of pituitary adenoma, anesthetic, vasodilator and analgesic sparing effect | Bilateral SPG block, injected between the middle and inferior turbinates | None | 1.5% lidocaine and epinephrine | 15 cases and 15 controls | Randomized-controlled | Significantly reduced in sevoflurane and nitroglycerine consumption, emergence time, postoperative pain and need of meperidine analgesia. |
Cho et al. [17] | 2011 | Endoscopic sinus surgery postoperative analgesia efficacy | Transoral, through the greater palatine foramen | None | 0.25% bupivacaine with epinephrine | 60 | Double-blind randomized, placebo-controlled | Pain not significantly different from control |
Kesimci et al. [22] | 2012 | Endoscopic sinus surgery postoperative analgesia efficacy | Bilateral SPG block, injected between the middle and inferior turbinates | None | 0.5% bupivacaine or 0.5% levobupivacaine | 45 | Double-blind randomized, placebo-controlled | Postoperative pain significantly reduced, also significantly few patients requiringadditional analgesics in the postoperative 24 h. |
Demaria et al. [21] | 2012 | Endoscopic sinus surgery postoperative analgesia efficacy | Bilateral SPG block, palatal approach | None | 2% lidocaine and 1% tetracaine | 70 | Double-blind randomized, placebo-controlled | Patients were discharged sooner than the control group. The block group also required less total fentanyl in the recovery room. |
Cady et al. [15] | 2015 | Chronic migraine | Tx360 | None | 0.5% bupivacaine | 38 | Double blind, placebo control | Significantly decreased headache at 24 h |
Cady et al. [16] | 2015 | Chronic migraine | Repetitive block (twice a week) with Tx360 | None | 0.5% bupivacaine | 38 | Double blind, placebo control | No statistical difference at 1 month and 6 months between treatment and control groups. |
Schaffer et al. [34] | 2015 | Acute anterior or global headache | Tx360 device | None | 0.5% bupivacaine | 93 | Randomized placebo-controlled | No statistically significant difference |
Al-Qudah et al. [19] | 2015 | Endoscopic sinus surgery postoperative analgesia efficacy | Applied to the SPG region | None | 2% lidocaine and epinephrine | 60 (30 cases, 30 controls) | Double-blind, placebo controlled | Significant pain reduction in the SPG block group |
Narouze et al. [38] | 2009 | Chronic cluster headache | Infrazygomatic approach | Fluoroscopy | NA | 15 | Prospective cohort | Mean attack intensity, mean attack frequency, pain disability index significant reduced at 1 year follow-up (P < 0.0005, P < 0.0003, P < 0.002, respectively) |
SPG Neurostimulation | ||||||||
Schoenen et al. [41] | 2013 | Cluster headache | ATI SPG stimulator positioned on the lateral-posterior maxilla medial to the zygoma. Customized, mean frequency 120.4 Hz, mean pulse width 389.7 us, mean intensity 1.6 mA | CT | – | 28 cases, with 3 randomized settings. | Randomized controlled | Pain relief achieved in 67.1% of full stimulation-treated attacks compared to 7.4% of sham-treated attacks. P < 0.0001 |
Jurgens et al. [42] | 2016 | Cluster headache | Neurostimulator, described in Schoenen et al. [41] | CT | – | 33 cases | Cohort study. Long-term follow-up from [41] | 61% of patients were either acute responder (>50% relief from moderate or greater pain) or frequency responder (>50% in attack frequency) at 24 months |
Barloese et al. [43] | 2016 | Cluster headache | Neurostimulator, described in Schoenen et al. [41] | CT | – | 33 cases | Cohort study. Long-term follow-up from [41] | 30% experienced at least 1 episode of complete attack remission (attack-free period exceeding 1 month) |
Sphenopalatine ganglion block
Cluster headache
Cluster headache | ||||||||
---|---|---|---|---|---|---|---|---|
Author | Year | Medical problems | Approach | Imaging | Medication | Number of cases | Study design | Outcome |
Devoghel et al. [52] | 1981 | Cluster headache | Needle injection. Supra-zygomatic approach | None | Pure alcohol | 120 | Case series | 85.8% had complete relief |
Barre et al. [7] | 1982 | Cluster headache | Cotton swab. Applied to sphenopalatine foramen. Self-application if responded to treatment | None | 50 mg of cocaine flakes, then 10% and 5% cocaine solution | 11 | Case series | 10 out of 11 had 50-100% abortion rate in spontaneous headache |
Kittrelle et al. [8] | 1985 | Cluster headache | Lidocaine directly dropped into the nostrils | None | 4% lidocaine | 5 | Case series | 4 of 5 patients obtained relief of nitrate-induced cluster headaches |
Costa et al. [6] | 2000 | Cluster headache (nitroglycerin induced) | Cotton tipped applicator, transnasal approach | None | 10% cocaine or 10% lidocaine | 6 episodic CH, 9 chronic CH | Double-blind, placebo-controlled, | All patients with induced pain responded to cocaine after 31.3 min and lidocaine after 37 min |
Felisati et al. [9] | 2006 | Chronic cluster headache | Endoscopic needle injection that approaches the pterygopalatine fossa by way of the lateral nasal wall | None | Triamcinolone acetonide, 1% bupivacaine and 2% mepivacaine with adrenaline | 21 | Case series | 11 out of 21 have improvement in symptoms |
Yang et al. [53] | 2006 | Chronic cluster headache | Transnasal needle | Fluoroscopy | 0.2% Ropivacaine and triamcinolone | 1 | Case report | 60% pain relief |
Pipolo et al. [10] | 2010 | Drug-resistant chronic cluster headache | Needle into the inferior portion of the sphenopalatine foramen (transnasal endoscopic technique-prasanna 1993 | None | 40 mg triamcinolone acetonide, 1% bupivacaine, 2% mepivacaine with adrenaline | 15 | Case series | 55% experience complete subsidence of CH symptoms |
Zarembinski et al. [54] | 2014 | Drug-resistant chronic cluster headache, with Jacob’s disease | Sphenopalatine ganglion block via mandibular notch, then radiofrequency oblation. | Fluoroscopy, CT | 0.25% bupivacaine and 10 mg/ml dexamethasone | 1 | Case report | Pain significantly improved. |
Kastler et al. [55] | 2014 | Cluster headache (14), persistent idiopathic facial pain (10), and other types of facial pain (18) | Infrazygomatic approach | CT | Absolute alcohol | 14 | Case series | 76.5% of patients have 50% pain relief at 1 month |
Trigeminal neuralgia
Trigeminal neuralgia | ||||||||
---|---|---|---|---|---|---|---|---|
Author | Year | Medical problems | Approach | Imaging | Medication | Number of cases | Study design | Outcome |
Peterson et al. [12] | 1995 | Trigeminal neuralgia | Cotton tip applicator | None | 4% lidocaine | 2 | Case series | Pain free |
Manahan et al. [13] | 1996 | Trigeminal neuralgia | NA | None | Bupivacaine | 1 | Case report | Pain free |
Kanai et al. [11] | 2006 | Second division trigeminal neuralgia | Nasal spray | None | Lidocaine | 25 | Randomized control | Significantly decreased pain with intranasal lidocaine spray |
Candido et al. [14] | 2013 | Trigeminal neuralgia, chronic migraine headache, post-herpetic neuralgia | Tx360 Nasal applicator, transnasal | None | 0.5% ropivacaine and 2 mg dexamethasone | 3 | Case series | Satisfactory |
Migraine
Migraine | ||||||||
---|---|---|---|---|---|---|---|---|
Author | Year | Medical problems | Approach | Imaging | Medication | Number of cases | Study design | Outcome |
Amster et al. [28] | 1948 | Migraine | Cotton tipped applicator, transnasal approach | None | Nupercaine, pontocaine, monocaine | 4 | Case series | Relief of pain and spasm in 90% of cases |
Maizels et al. [56] | 1999 | Migraine with aura | Self-administered intranasal 4% lidocaine | None | 4% lidocaine | 1 | Case report | Most headaches were successfully aborted for 15 months |
Yarnitsky et al. [57] | 2003 | Migraine | Cotton tip applicator | None | 2% lidocaine | 32 | Case series | Significant reduction in pain score during migraine |
Cady et al. [15] | 2015 | Chronic migraine | Tx360 | None | 0.5% bupivacaine | 38 | Double blind, placebo control | Significantly decreased headache at 24 h |
Cady et al. [16] | 2015 | Chronic migraine | Tx360 | None | 0.5% bupivacaine | 38 | Double blind, placebo control | No statistical difference at 1 month and 6 months between treatment and control groups. |
Postoperative pain of the head and face
Operative Pain of the head and neck | ||||||||
---|---|---|---|---|---|---|---|---|
Author | Year | Medical problems | Approach | Imaging | Medication | Number of cases | Study design | Outcome |
Robiony et al. [24] | 1998 | Skeletal transverse discrepancy of the maxilla | Transcutaneous truncal anesthesia of the maxillary nerve in association with transmucosal anesthesia of the sphenopalatine ganglion | None | Prilocaine carbocaine cream | 12 | Case series | Total anesthesia of the maxillary area facilitated the operations and appreciably reduced amount of postoperative pain |
Hwang et al. [23] | 2003 | Removal of nasal packing after nasal operation | Needle injection into the greater palatine canal | None | 1% lidocaine | 11 | Case-control | Injection side had significantly lower pain than the control side |
Ahmed et al. [18] | 2007 | Endoscopic sinonasal surgery intraoperative isofluorane consumption, hypotensive agents used, postoperative pain | Bilateral SPG block, injected between the middle and inferior turbinates | None | 0.5% lidocaine and epinephrine. | 15 cases, 15 controls | Randomized-controlled | Significantly reduced intraoperative isofluorane consumption and esmolol use, postoperative tramadol use and postoperative pain. |
Ali et al. [20] | 2010 | Endoscopic trans-nasal resection of pituitary adenoma, anesthetic, vasodilator and analgesic sparing effect | Bilateral SPG block, injected between the middle and inferior turbinates | None | 1.5% lidocaine and epinephrine | 15 cases and 15 controls | Randomized-controlled | Significantly reduced in sevoflurane and nitroglycerine consumption, emergence time, postoperative pain and need of meperidine analgesia. |
Kesimci et al. [22] | 2012 | Endoscopic sinus surgery postoperative analgesia efficacy | Bilateral SPG block, injected between the middle and inferior turbinates | None | 0.5% bupivacaine or 0.5% levobupivacaine | 45 | Double-blind randomized, placebo-controlled | Postoperative pain significantly reduced, also significantly few patients requiring additional analgesics in the postoperative 24 h. |
Demaria et al. [21] | 2012 | Endoscopic sinus surgery postoperative analgesia efficacy | Bilateral SPG block, palatal approach | None | 2% lidocaine and 1% tetracaine | 70 | Double-blind randomized, placebo-controlled | Patients were discharged sooner than the control group. The block group also required less total fentanyl in the recovery room. |
Al-Qudah et al. [19] | 2015 | Endoscopic sinus surgery postoperative analgesia efficacy | Applied to the SPG region | None | 2% lidocaine and epinephrine | 60 (30 cases, 30 controls) | Double-blind, placebo controlled | Significant pain reduction in the SPG block group |
Head and neck cancer pain
Head and neck cancer pain | ||||||||
---|---|---|---|---|---|---|---|---|
Author | Year | Medical problems | Approach | Imaging | Medication | Number of cases | Study design | Outcome |
Prasanna et al. [58] | 1993 | Pain from carcinoma of the tongue and floor of the mouth | Nasal sinuscope | None | 0.25% bupivacaine | 10 | Case series | Immediate pain relief |
Varghese et al. [25] | 2001 | Pain due to advanced head and neck cancer | Endoscopic needle injection | None | 6% phenol | 22 | Case series | 17 out of 22 patients had significant pain relief |
Varghese el al. [59] | 2002 | Pain due to advanced head and neck cancer | Transnasal through the sphenopalatine foramen | None | 6% phenol | 1 | Case report | Significant pain relief |
Postherpetic neuralgia
Postherpetic neuralgia | ||||||||
---|---|---|---|---|---|---|---|---|
Author | Year | Medical problems | Approach | Imaging | Medication | Number of cases | Study design | Outcome |
Prasanna et al. [26] | 1993 | Postherpetic neuralgia involving the ophthalmic division of the trigeminal nerve | Combination of stellate ganglion and sphenopalatine ganglion block, cotton tip applicator | None | Lidocaine and bupivacaine | 1 | Case report | Pain free |
Saberski et al. [27] | 1999 | Sinus arrest in postherpetic neuralgia | Cotton tipped applicator, transnasal approach | None | 20% lidocaine | 1 | Case report | No paroxysmal pain or sinus pauses immediately after block |
Amster et al. [28] | 1948 | Herpes zoster | Cotton tipped applicator, transnasal approach | None | Nupercaine, pontocaine, monocaine | 3 | Case series | Relief of pain and spasm in 90% of cases |
Musculoskeletal pain
Musculoskeletal pain | ||||||||
---|---|---|---|---|---|---|---|---|
Author | Year | Medical problems | Approach | Imaging | Medication | Number of cases | Study design | Outcome |
Amster et al. [28] | 1948 | Lumbosacral and sacroiliac pain | Cotton tipped applicator, transnasal approach | None | Nupercaine, pontocaine, monocaine | 61 | Case series | Relief of pain and spasm in 90% of cases |
Ruskin et al. [29] | 1946 | Lumbo-sacral spasm | Unknown | None | Cocaine, novocaine or nupercaine | 36 | Case series | Pain partially or completely relieved with SPGB and intramuscular injections of ironyl and calcium ascorbate |
Berger et al. [32] | 1986 | Low back pain | Cotton tip applicator and transnasal needle | None | Cocaine or lidocaine | 7 cases with cocaine, 7 cases with lidocaine, 7 controls | Case-control | No statistical significance between cases and controls |
Scudds et al. [3] | 1995 | Chronic muscle pain syndrome | Cotton tipped applicator, transnasal approach | None | 4% lidocaine | 42 with fibromyalgia, 19 with myofascial pain syndrome | Double-blind randomized controlled | No statistical significance between 4% lidocaine and placebo |
Janzen et al. [30] | 1997 | Myofascial pain syndrome and fibromyalgia | Nasal spray | None | 4% lidocaine | 42 with fibromyalgia, 19 with myofascial pain syndrome | Double-blind, placebo-controlled | No statistical significance between 4% lidocaine and placebo |
Ferrante et al. [31] | 1998 | Myofascial pain syndrome of the head, neck and shoulders | NA | None | 4% lidocaine | 13 cases, 7 controls | Double-blind, placebo-controlled, crossover design | No statistical significance |
Postdural puncture headache
Postdural puncture headache | ||||||||
---|---|---|---|---|---|---|---|---|
Author | Year | Medical problems | Approach | Imaging | Medication | Number of cases | Study design | Outcome |
Cohen et al. [60] | 2014 | Postdural puncture headache | Cotton-tip applicator | None | 5% lidocaine | 32 | Case series | 69% of the patients were saved from epidural blood patch |
Kent et al. [4] | 2015 | Postdural puncture headache | Cotton-tip applicator | None | 2% lidocaine | 3 | Case series | 1 patient had relief, 2 had to get epidural blood patch. |
Cardoso et al. [61] | 2017 | Postdural puncture headache | Cotton-tip applicator | None | 0.5% Levobupivacaine | 1 | Case report | Symptoms relieved by 5 min. |
Other pain syndromes of the head and face
Pain syndromes of the head and face | ||||||||
---|---|---|---|---|---|---|---|---|
Author | Year | Medical problems | Approach | Imaging | Medication | Number of cases | Study design | Outcome |
Ruskin et al. [62] | 1925 | SP maxillary neuralgia, SP facial neuralgia, SP sympathetic neuralgia, SPG cell neuralgia | Needle injection. | None | 20% Cocaine, 10% silver nitrate, 70% alcohol | 7 | Case series | Improvements or complete relief |
Stechison et al. [63] | 1994 | Post-traumatic atypical facial pain syndrome | Needle injection. Transfacial transpterygomaxillary access to foramen rotundum SPG and maxillary nerve | CT | First stage: 0.5% bupivacaine, Second stage: 98% ethyl alcohol and 0.5% bupivacaine in 2:1 ratio | 5 | Case series | 3 had alcohol neurotomy and pain free at 5, 8 and 12 months. 2 responded poorly to first stage blockade and did not have alcohol neurotomy. |
Peterson et al. [12] | 1995 | Atypical odontalgia | Cotton tip, self-application | None | 4% lidocaine | 1 | Case report | Pain free |
Saade et al. [64] | 1996 | Pain from midline granuloma | Self-administered SPG block | None | Lidocaine | 1 | Case report | Significant pain relief |
Puig et al. [65] | 1998 | Sluder’s neuralgia | Cotton tip applicator and transnasal needle | None | 88% phenol | 8 | Case series | 90% decrease in head and face pain for 9.5-month duration |
Windsor et al. [66] | 2004 | Herpetic keratitis | Transnasal cotton tip applicator | None | Tetracaine, adrenalin and 10% cocaine] | 1 | Case report | Effect of block lasts for a month. Requires months blocks |
Obah et al. [67] | 2006 | Hemifacial and headache | Transnasal | None | 4% lidocaine | 1 | Case report | 80% reduction in pain intensity |
Cohen et al. [33] | 2009 | Postdural puncture headache | Cotton tip applicator | None | Lignocaine | 13 | Case series | 11 out of 13 had immediate relief of headache |
Morelli et al. [68] | 2010 | Paroxysmal hemicrania resistant to multiple therapies | Endoscopic needle injection into the nasal mucous membrane immediately behind and over the inferior portion of the sphenopalatine foramen and into the fossa | None | Triamcinolone acetonide, 1% bupivacaine, 2% mepivacaine with adrenalin | 1 | Case report | Reduction in frequency and intensity of pain |
Rodman et al. [35] | 2012 | Nasal pain or headache | Endoscopic needle injection | None | 0.5% bupivacaine and triamcinolone acetonide | 147 | Case series | 81.3% of patients have improvement |
Grant et al. [69] | 2014 | Tension headache in pregnant woman | Cotton tip applicator | None | 4% lidocaine | 1 | Case report | BID block for a total of 7 blocks, pain free after |
Kastler et al. [55] | 2014 | Cluster headache (14), persistent idiopathic facial pain (10), and other types of facial pain (18) | Infrazygomatic approach | CT | Absolute alcohol | 28 | Case series | 85.7% of patient with persistent idiopathic facial pain and 40% of other types of facial pain had 50% pain relief at 1 month |
Androulakis et al. [70] | 2016 | Hemicrania continua | Tx360 device | None | Repetitive 0.5% bupivacaine | 1 | Case report | Significant improvement in headache by 14 week |
Malec-Milewska et al. [71] | 2015 | Trigeminal neuropathy | Zygomatic approach | Fluoroscopy | 65% ethanol with lidocaine | 20 | Case series | Significant pain relief |
Schaffer [34] | 2015 | Acute anterior or global headache | Tx360 device | None | 0.5% bupivacaine | 93 | Randomized placebo-controlled | No statistically significant difference |
Sussman et al. [72] | 2016 | Chronic posttraumatic headache after sport-related concussion | Cotton-tip applicator | None | 2% lidocaine and 0.5% bupivacaine | 1 | Case report | Symptom free at 6-month follow-up |
Other syndromes
Other syndromes | ||||||||
---|---|---|---|---|---|---|---|---|
Author | Year | Medical problems | Approach | Imaging | Medication | Number of cases | Study design | Outcome |
Byrd et al. [73] | 1930 | “Remote dysfunctions” | Cotton tipped applicator, transnasal approach | None | 50% butyn | Over 2000 cases | Case series | Remote dysfunctions were arrested |
Sparer et al. [74] | 1935 | Recurrent convulsive seizures associated with nasal pathology | Needle injection | None | Mixture of alcohol and novocaine | 3 | Case series | Cessation of seizures |
Ruskin et al. [29] | 1946 | Muscle spasms and arthritic pain | Unknown | None | cocaine, novocaine or nupercaine | 68 | Case series | Pain partially or completely relieved with SPGB and intramuscular injections of ironyl and calcium ascorbate |
Amster et al. [28] | 1948 | 4 migraine, 2 acute torticollis, 12 painful spastic shoulder, 2 intercostal neuritis, 3 herpes zosters, 4 persistent hiccups, 5 ureteral colic, 3 dysmenorrhea, 7 peripheral painful vascular spasm, 61 lumbosacral and sacroiliac pain | Cotton tipped applicator, transnasal approach | None | Nupercaine, pontocaine, monocaine | 103 | Case series | Relief of pain and spasm in 90% of cases |
Ruskin et al. [75] | 1949 | Arthritic pain | Unknown | None | Unknown | 30 | Case series | Pain partially or completely relieved with SPGB and iron salt of the adenylic nucleotide |
Slade et al. [51] | 1986 | Tear secretion with topical anesthesia | Needle injection, through the greater palatine foramen | None | 2% lidocaine | 10 | Case-control (using self as control) | Tear secretion significantly reduced by 73% (p < 0.001) |
Henneberger et al. [36] | 1988 | Nicotine addiction | Cotton tipped applicator, transnasal approach | None | Bupivacaine, cocaine or saline | 6 with bupivacaine, 5 with cocaine, 6 with saline | Double-blind placebo-controlled | Significantly fewer symptoms of discomfort for patients in the anesthetic treatment groups than the placebo group |
Silverman et al. [37] | 1993 | Experimentally induced pain (submaximal effort tourniquet test) | Cotton tipped applicator | None | 20% lidocaine and epinephrine | 16 healthy volunteers | Double-blind, cross-over study | No significant difference between experimental and placebo groups |
Quevedo et al. [76] | 2005 | Complex regional pain syndrome involving the lower extremity | Cotton tip applicator, transnasal | None | 4% tetracaine | 2 | Case series | 50% pain reduction |
Triantafyllidi et al. [77] | 2016 | Hypertension | Cotton tip applicator, transnasal | None | 2% lidocaine | 22 | Cohort study | Systolic blood pressure significantly decreased by 24 hrs and by 21-30 days |
Summary for SPG block
Radiofrequency ablation
Cluster headache
Cluster headache | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
First author | Year | Medical problem | Approach | Imaging | Temperature (°C) | Type of RFA | Parameter | How to identify right spot | Study design | Number of cases | Outcome |
Sanders et al. [39] | 1997 | Cluster headache | Infrazygomatic approach | Fluoroscopy | 70 | High frequency | 50 Hz, 0.2-1 V | Paresthesia in the palate | Case-only | 66 | 60.7% of episodic cluster headache patients received complete relief, 30% in chronic cluster headache patients achieved complete relief |
Narouze et al. [38] | 2009 | Chronic cluster headache | Infrazygomatic approach | Fluoroscopy | 80 | Unknown | 50 Hz at <0.5 V to produce deep paresthesia behind the root of the nose | . | Prospective cohort | 15 | Mean attack intensity, mean attack frequency, pain disability index significant reduced at 1 year follow-up (P < 0.0005, P < 0.0003, P < 0.002, respectively) |
Chua et al. [78] | 2011 | Cluster headaches | Infrazygomatic approach | Fluoroscopy | 42 | Pulsed | 50 Hz, 0.5-0.7 V | Paresthesia at the root of the nose | Case series | 3 | Two had excellent relief, one had partial relief by 2 months |
Oomen et al. [79] | 2012 | Atypical facial pain, cluster headache, Sluder’s neuralgia, Sluder’s neuropathy | Infrazygomatic approach | Fluoroscopy | 80 | Unknown | 50 Hz | Paresthesia in the nose and not in the area of the maxillary nerve | Case series | 3 | Adequate pain reduction: 4/4 in atypical facial pain, 2/3 in cluster headache, 1/2 in Sluder’s neuralgia, 2/2 in Sluder’s neuropathy, 1/1 in posttraumatic neuropathy, 0/1 in post-herpetic neuralgia, 0/1 in SUNCT (60% showed considerable pain relief after a single procedure). |
Zarembinski et al. [54] | 2014 | Drug-resistant chronic cluster headache, with Jacob’s disease | Initially sphenopalatine ganglion block, then radiofrequency. | Fluoroscopy, CT | Unknown | Unknown | Unknown | NA | Case report | 1 | Pain significantly improved. |
Fang et al. [80] | 2015 | Cluster headache | Infrazygomatic approach | CT | 42 | Pulsed | Unknown | 0.1-0.3 V to induce paresthesia of the nasal root | Case series | 16 | 11 episodic and 1 chronic cluster headache patients had complete relief by 6.3 days. 2 episodic and 2 chronic cluster headache patients had no relief. |
Bendersky et al. [81] | 2015 | Cluster headache | Infrazygomatic approach | Fluoroscopy | 42 | Pulsed | 45 V, 2 Hz, pulse width 20 ms | Paresthesia at the roof of the nose | Case series | 3 | 2 patients had no relief, 1 had relief until 1 month. Continue RFA gave relief to all three patients. |
Dharmavaram et al. [82] | 2016 | Cluster headache | Lateral approach | Fluoroscopy | 80 | Continuous | Unknown | paresthesia at the root of the nose was obtained at 0.3 V | Case report | 1 | Pain free for 2 months |
Loomba et al. [83] | 2016 | Cluster headache | Infrazygomatic approach | CT | 80 | Continuous | 50 Hz | <0.3 V to induce paresthesia of the nasal root | Case report | 1 | Near complete resolution at 6 months |
Other head and facial pain
First author | Year | Medical problem | Approach | Imaging | Temperature (°C) | Type of RFA | How to identify the right spot | Study design | Number of cases | Outcome |
---|---|---|---|---|---|---|---|---|---|---|
Salar et al. [50] | 1987 | Sluder’s neuralgia | Lateral extraoral approach | Fluoroscopy | 60 and 65 | Continuous | 0.2-0.3 V, paresthesia in the distribution of the maxillary nerve | Case series | 7 | Disappearance of the typical pain attacks, lacrimation and nasal secretion, however, a slight, deep-seated troublesome sensation persisted |
Shah et al. [84] | 2004 | Posttraumatic headache | Infrazygomatic approach | Fluoroscopy | 42 | Pulsed | 50 Hz and 0.5 V produced tingling sensation at the root of the nose | Case report | 1 | Pain reduced from 10/10 to 1/10 |
Bayer et al. [85] | 2005 | Chronic head and face pain | Infrazygomatic approach | Fluoroscopy | 42 | Pulsed | 50 Hz up to 1 V, paresthesia elicited at the roof of the nose, motor stimulation performed at 2 Hz to rule out trigeminal contact, which results in rhythmic mandibular contraction | Case series | 30 | 21% had complete pain relief, 65% had moderate pain relief, 14% had no pain relief. |
Nguyen et al. [86] | 2010 | Atypical trigeminal neuralgia | Coronoid approach | Fluoroscopy | 42 | Pulsed | 50 Hz with 1 ms pulse duration, 0.6 V | Case report | 1 | Symptom-free after 2 yrs. |
Oomen et al. [79] | 2012 | Atypical facial pain, cluster headache, Sluder’s neuralgia, Sluder’s neuropathy | Infrazygomatic approach | Fluoroscopy | 80 | Unknown | 50 Hz, paresthesia in the nose and not in the area of the maxillary nerve | Case series | 4 atypical facial pain, 2 Sluder’s neuralgia, 2 Sluder’s neuropathy, 1 post-traumatic neuropathy of infraorbital nerve, 1 postherpetic neuralgia, 1 SUNCT | Adequate pain reduction: 4/4 in atypical facial pain, 2/3 in cluster headache, 1/2 in Sluder’s neuralgia, 2/2 in Sluder’s neuropathy, 1/1 in posttraumatic neuropathy, 0/1 in post-herpetic neuralgia, 0/1 in SUNCT (60% showed considerable pain relief after a single procedure). |
Elahi et al. [87] | 2014 | Facial pain secondary to cavernous sinus meningioma removal | Infrazygomatic approach | Fluoroscopy | 80 | Continuous | 50 Hz, paresthesia in the nasolabial midline region | Case report | 1 | Satisfactory pain relief at 12 months |
Akbas et al. [40] | 2016 | Atypical facial pain, SPG neuralgia due to herpes zoster, atypical Trigeminal neuralgia | Infrazygomatic approach | Fluoroscopy | 42 | Continuous | Paresthesia at the roof of the nose at 0.5–0.7 V. To rule out trigeminal contact, motor stimulation at a frequency of 2 Hz was applied | Case series | 27 | Pain relief not achieved in 23%, completely relieved in 35% and moderately relieved in 42% of patients |
Summary for SPG radiofrequency ablation
Sphenopalatine ganglion neurostimulation
Neurostimulation | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
First author | Year | Medical problem | Stimulator | Approach | Imaging | Types of stimulation | How to identify the right spot | Study design | Number of cases | Outcome |
Tepper et al. [45] | 2009 | Intractable migraine | Medtronic model 3625 or 3628 | Infrazygomatic approach | Fluoroscopy | Customized, average amplitude, 1.2 V, pulse rate 67 Hz, pulse width 462 μs | Paresthesia with stimulation at the back of the nose and deep in the back of the soft palate | Case only | 11 | 2 pain-free, 3 had pain reduction, 5 had no response, 1 was not stimulated |
Ansarinia et al. [44] | 2010 | Cluster headache | Medtronic model 3625 | Pterygopalatine fossa | Fluoroscopy | Customized, average amplitude, 1.7 V, frequency 88 Hz, pulse width 294 μs | paresthesia with stimulation in the posterior nasopharynx and root of the nose | Case only | 6 | Total 18 CH attacks, complete resolution with SPG stimulation in 11 attacks, partial in 3, no relief in 4. |
Schoenen et al. [41] | 2013 | Cluster headache | ATI SPG stimulator | Pterygopalatine fossa proximate to the sphenopalatine ganglion | CT | Customized, mean frequency 120.4 Hz, mean pulse width 389.7 μs, mean intensity 1.6 mA | X-ray | Randomized controlled | 28 cases, with 3 randomized settings. | Pain relief achieved in 67.1% of full stimulation-treated attacks compared to 7.4% of sham-treated attacks. P < 0.0001 |
Elahi et al. [47] | 2015 | Idiopathic right facial pain | Medtronic model 3378 | The pterygopalatine fossa | Fluoroscopy | 0.5 mV, pulse width 250 – 450 μs, and 40 – 80 Hz | X-ray | Case report | 1 | 2/10 pain on 6-month follow-up |
Meng et al. [88] | 2016 | Cluster headache | Medtronic model 3487A | Pterygopalatine fossa | Fluoroscopy | Bilateral stimulation, right 0-, 1+, 130 Hz, 120 μs, 0.7 V; left 8-, 9+, 130 Hz, 120 μs, 0.8 V | X-ray | Case report | 1 | Headache frequency reduced to once a week, pain level 1/10 at 4 months |
William et al. [46] | 2016 | Idiopathic facial pain, supraorbital neuropathy, hemicrania continua, facial anesthesia dolorosa, occipital neuropathy | Medtronic Subcompact Octrode | SPG | Fluoroscopy | Unknown | X-ray | Case series | 5 | 80% reported sustained facial pain at mean follow-up of 9.6 months. |
Jurgens et al. [42] | 2016 | Cluster headache | Neurostimulator, described in [41] | Pterylopalatine fossa | CT | Customized, applied as soon as the patient feels cluster headache attacks | X-ray | Cohort study. Long-term follow-up from [41] | 33 cases | 61% of patients were either acute responder (>50% relief from moderate or greater pain) or frequency responder (>50% in attack frequency) at 24 months |
Barloese et al. [43] | 2016 | Cluster headache | Neurostimulator, described in [41] | Pterylopalatine fossa | CT | Customized, applied as soon as the patient feels cluster headache attacks | X-ray | Cohort study. Long-term follow-up from [41] | 33 cases | 30% experienced at least 1 episode of complete attack remission (attack-free period exceeding 1 month). |