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) |