Post op case of open pancreaticoduodenectomy, portal lymphadenectomy, retroperitoneal lymphadenectomy for ca pancreas. Afterward had 10/10 severe shoulder tip pains that nothing would help. Given a prior study found SPGB might help post op, attempted SPGB with a brilliant design, and got pain from 5/10 to 0/10 by end of procedure. I have always wondered whether it could save the day elsewhere as there are sporadic reports of help in odd conditions.
Levin D, Acquadro M, Cerasuolo J, Gerges F.
Sphenopalatine ganglion block for ipsilateral shoulder pain following open pancreaticoduodenectomy. BMJ Case Rep. 2022;15(1):e243746. Published 2022 Jan 6. doi:10.1136/bcr-2021-243746
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8739062/
- 59 year old female for pancreatic cancer surgery
- 10/10 pain to start; was 5/10 before procedure
- opioids, ketorolac IV, and lidocaine patch failed.
- “pain as sharp and needle-like sensation inside her shoulder” – excruciating at times
- 59 year old female for pancreatic cancer surgery
- 10/10 pain to start; was 5/10 before procedure
- opioids, ketorolac IV, and lidocaine patch failed.
- “pain as sharp and needle-like sensation inside her shoulder” – excruciating at times
Treatment process:
- supplies: – lidocaine 4% topical solution, lidocaine 5% ointment, scissors, hollow cotton-tips, 3 cc syringes, Anaesthesia IV sets
- Applicator inserted with 5% lisocaine ointment – numbing up front area makes procedure much more pleasant. – applicators inserted bilaterally
- Put in upper posterior nasopharnyx
- “Lidocaine 4% was dripped drop by drop through the applicators into each nostril until the patient felt the medication in the back of her throat (1 mL into the right nostril and 0.5 mL into the left nostril) (figure 3). The SPGB applicators were left in place for a total of 15 min.”
- Important tip – felt that “once a patient feels the medication in the back of the throat, the medication has reached the SPGB”
- From the looks of below, there is not much trouble hooking up IV tubing to swab:
Another example of odd use for SPGB is for shingles pain on the chest:
Use in Back pain:
Wilson, Peter R.
Sphenopalatine Block: The Cheapest Technique in the management of Chronic Pain.
The Clinical journal of pain 7.3 (1991): 256.
https://journals.lww.com/clinicalpain/Citation/1991/09000/Sphenopalatine_Block__The_Cheapest_Technique_in.20.aspx
went through a series of techniques:
their findings:
Couple cases of Complex Regional Pain Syndrome (CRPS) helped by SPGB:
Complex regional pain syndrome involving the lower extremity: A report of 2 cases of sphenopalatine block as a treatment option
Jonathan P.Quevedo et al.
Archives of Physical Medicine and Rehabilitation 86(2), February 2005,335-337
https://www.sciencedirect.com/science/article/abs/pii/S0003999304006288#aep-abstract-id7
- “Two culturette swabs are dipped in a bottle of 4% tetracaine; one is placed in 1 nare and advanced gently under the inferior turbinate until it reaches the area of the branch of the SPG.” (This is different from some that say you advance below middle turbinate)
- If it is advanced too far and reaches the posterior nasopharynx, it must be withdrawn approximately 2.45cm (1in)”
- each swab is rotated after 5 to 7 minutes, so that a different part of the cotton swab touches
- Keep in for 10 to 15 minutes,
- “The patient is instructed not to blow his/her nose for 30 minutes.”
Cases:
One case:
- 28 yr old lady – fall with CRPS shin to ankle pains
- Amitriptyline 75 mg and baclofen some relief
- waiting long term for lumbosacral sympathetic blockade – story I often hear – how useful is something you wait months for? with COVID that could be 6 months! When she finally had, they did not work.
- SPGB would drop pain from 8/10 – 4/10 for a week – after several goes, was taught self blocks:
This self block was based on:
Saade, E., & Paige, G. B. (1996).
Patient-administered sphenopalatine ganglion block.
Regional Anesthesia, 21(1), 68-70
https://www.proquest.com/docview/2553067182?pq-origsite=gscholar&fromopenview=true
other case:
- 45 year old lady with post TBI had Achilles surgery and 6/10 burning pain subsequently.
- SPGB would work it down to 2-3/10 for 4-5 weeks but only in combination with gabapentin 900 mg tid
newpainmuse 