Transnasal Versus Suprazygomatic SPG Block in Persistant Idiopathic Facial Pain

NCT ID: NCT06496841

Last Updated: 2024-08-05

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 40 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2022-10-01
• Study Completion Date: 2023-04-02

Brief Summary

The International Headache Society defines persistent idiopathic facial pain (PIFP) as persistent facial pain that does not have the characteristics of cranial neuralgia, is blunt, persistent, persistent, bothersome and not attributable to another disorder. The management of persistent idiopathic facial pain (PIFP) is complex. The sphenopalatine ganglion (SPG) has been the target of interventional treatment of many facial pain syndromes. The sphenopalatine ganglion can be accessed by transnasal access and ultrasound or scopy guidance. In this study, datas compared the efficacy of transnasal approach and ultrasound-guided suprazigomatic approach in sphenopalatine ganglion block in patients with persistent idiopathic facial pain.

Detailed Description

Patients with chronic head and facial pain are frequently referred to us and some of these patients are persistent idiopathic facial pain patients who do not respond to conservative treatment. Various interventional treatment modalities can be applied to these patients. One of the treatments we frequently apply is sphenopalatine ganglion (SPG) blockage, which has an important place in the pathogenesis of chronic headache. The SPG is the target area for the treatment of cluster headache, migraine, postherpetic neuralgia, trigeminal neuralgia and other atypical facial pain syndromes due to its anatomical localisation and its role in the trigemino-cervical reflex. Although there are various techniques for SPG block, the simplest and most easily applicable is the transnasal approach and the traditional method is to apply a block with a cotton-tipped swab. Various local anaesthetics can be used, the most commonly used local anaesthetic is 2-3 ml of 2% or 10% lidocaine, usually administered through one nostril for 30 minutes. It is also possible to access SPG via the suprazygomatic route, and studies have shown that SPG block applied via the suprazygomatic route provides effective treatment of chronic headaches. In ultrasound-guided SPG block, after visualising the pterygopalatine fossa with USG, 3-4 mL of 2% lidocaine is administered to the area and blockage is achieved.

Our study was designed retrospectively. The primary aim of the study was to compare the efficacy of transnasal and suprazigomatic routes based on Numerical Rating Scale (NRS) pain scores by reviewing the files of patients who underwent sphenopalatine ganglion block for persistent idiopathic facial pain. The pain scores recorded before the procedure and one and four weeks after the procedure will be compared.

In this study, primary aim is to evaluate the efficacy of these two treatment modalities, with retrospectively evaluate the Visual Analogue Scale (VAS) score, HIT-6 (Headache Impact Test-6) score and headache diary data of the patients who have previously undergone these treatments in the pain clinic.

Conditions

Headache; Persistent Idiopathic Facial Pain

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: RETROSPECTIVE

Study Groups

Transnasal sphenopalatine ganglion block group

transnasal administration of lidocaine to the sphenopalatine ganglion

Transnasal Sphenopalatine ganglion block

Intervention Type: DRUG

The transnasal approach to the sphenopalatine ganglion block allows for non-invasive access to the sphenopalatine ganglion, which is located deep in the nasopharynx in a recess posterior to the middle turbinate. A long cotton swab is inserted posterior to the nasopharynx until it is properly seated, and 2 mL of 2% lidocaine is injected through the outer end of the swab and left for 30 minutes. Patients are monitored for any potential complications or adverse effects throughout the procedure and for a period of time afterwards.

Ultrasound-guided suprazygomatic sphenopalatine ganglion block group

ultrasound-guided suprazygomatic approach

Ultrasound-guided suprazygomatic sphenopalatine ganglion block

Intervention Type: DRUG

The ultrasound transducer is placed in the infrazygomatic area, above the maxilla, at approximately a 45 cephalad angle. With this transducer position, the ptrigopalatine fossa, bounded anteriorly by the maxilla and posteriorly by the pterygoid process, is visualized. A 25 gauge spinal needle is inserted 1 to 1.5 cm above the zygomatic arch and posterior to the posterior orbital rim and advanced through an out-of-plane approach to reach the pterigolapalatine fossa. After the aspiration test, 3 mL of 2% lidocaine is injected and the spread of the drug is monitored by ultrasound. Patients are monitored for possible side effects and complications.

Interventions

Transnasal Sphenopalatine ganglion block

The transnasal approach to the sphenopalatine ganglion block allows for non-invasive access to the sphenopalatine ganglion, which is located deep in the nasopharynx in a recess posterior to the middle turbinate. A long cotton swab is inserted posterior to the nasopharynx until it is properly seated, and 2 mL of 2% lidocaine is injected through the outer end of the swab and left for 30 minutes. Patients are monitored for any potential complications or adverse effects throughout the procedure and for a period of time afterwards.

Intervention Type: DRUG

Ultrasound-guided suprazygomatic sphenopalatine ganglion block

The ultrasound transducer is placed in the infrazygomatic area, above the maxilla, at approximately a 45 cephalad angle. With this transducer position, the ptrigopalatine fossa, bounded anteriorly by the maxilla and posteriorly by the pterygoid process, is visualized. A 25 gauge spinal needle is inserted 1 to 1.5 cm above the zygomatic arch and posterior to the posterior orbital rim and advanced through an out-of-plane approach to reach the pterigolapalatine fossa. After the aspiration test, 3 mL of 2% lidocaine is injected and the spread of the drug is monitored by ultrasound. Patients are monitored for possible side effects and complications.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Diagnosis of persistent idiopathic facial pain according to ICHD-3 beta criteria
• Moderate to severe pain (pain of 6 or more on a numeric pain scale of 0-10)
• Persistence of pain for more than 6 months
• Pain unresponsive to conservative methods

Exclusion Criteria

• Presence of secondary headache (tumor, bleeding, stroke, etc.)
• Cognitive impairment
• Hepatic or renal insufficiency
• Local or systemic infection
• Coagulopathy
• Patient refusal to accept treatment

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Diskapi Teaching and Research Hospital

OTHER

Sponsor Role: lead

Responsible Party

Damla Yürük

Principal investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Ömer Taylan Akkaya, MD

Role: STUDY_DIRECTOR

Diskapi Teaching and Research Hospital

Ezgi Can, MD

Role: PRINCIPAL_INVESTIGATOR

Diskapi Teaching and Research Hospital

Locations

Ankara Etlik City Hospital

Ankara, Yenimahalle, Turkey (Türkiye)

Countries

Turkey (Türkiye)

Other Identifiers

SPG block

Identifier Type: -

Identifier Source: org_study_id