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Table 2 Studies with evidence level above case series in SPG block, radiofrequency ablation and neurostimulation

From: Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review

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)
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