Measurement and implications of the distance between the sphenopalatine ganglion and nasal mucosa: a neuroimaging study

Crespi, Joan; Bratbak, Daniel; Dodick, David; Matharu, Manjit; Jamtøy, Kent Are; Aschehoug, Irina; Tronvik, Erling

doi:10.1186/s10194-018-0843-5

Table 2 Summary of studies evaluating topical intranasal administration of LA in pain disorders of the head and face

From: Measurement and implications of the distance between the sphenopalatine ganglion and nasal mucosa: a neuroimaging study

Author	Drug	Concen-tration	Volume	Condition	RCT	Effect	Nr of patients	Technique	Ref.
Sluder	Cocaine	4–70%	A drop	Meckel’s ganglion neuralgia	No	Positive effect in a series of patients	5	Applicator, surgery	[7]
	Alcohol	–	A drop
	formaldehyde	0,4%	N/S
	Silver nitrate	2%	N/S
Barre	Cocaine	5–10%	N/S	CH	No	Positive effect in a series of patients	11	Barre’s technique^a	[20]
Kittrelle	Cocaine	5%	–	CH (NTG-induced)	No	> 75% reduction in headache intensity within 3 min, in 4 of 5 patients with lidocaine	5	Barre’s technique^a	[12]
Kittrelle	lidocaine	4%	1 ml	CH (NTG-induced)	No		5	Barre’s technique^a	[12]
Hardebo	Cocaine	10%	0,3 ml	CH	No	Lidocaine and cocaine equally effective	24	Nasal droper	[27]
Hardebo	Lidocaine	4%	0,5–0,8 ml	CH	No	Lidocaine and cocaine equally effective	24	Nasal droper	[27]
Robbins	Lidocaine	4%	4–6 sprays	CH	No	54% mild to moderate relief after treatment	30	Spray	[26]
Kudrow	Lidocaine	4%	0,4 ml	Migraine	No	Migraine attacks aborted in 12 of 23 patients	23	Barre’s technique^a	[38]
Maizels	Lidocaine	4%	0,5 ml	Migraine	Yes	55% of patients that received lidocaine had at least 50% reduction of headache within 15 min (primary endpoint)	81	Barre’s technique^a	[4]
Maizels	Lidocaine	4%	0,5 ml	Migraine	Yes	Randomized trial with open-label follow-up. Controlled trial: 35.8% of patients had headache relieved to mild or none 15 min. After treatment.	131	Barre’s technique^a	[5]
Maizels	Lidocaine	4%	0,5 ml	Migraine	No	Prevention of the development of headache following aura.	1	Barre’s technique^a	[39]
Saberski	Lidocaine	20%	N/S	Postherpetic neuralgia	No	Decrease of the pain (therapy repeated 11 times)	1	Applicator dipped in anaesthetic	[40]
Costa	Lidocaine	10%	1 ml	CH (NTG-induced)	Yes	All patients responded to both anaesthetics with complete cessation of induced pain (31.3 ± 13.1 min for cocaine and 37.0 ± 7.8 for lidocaine. For saline, pain severity increased initially and resolved with a latency of 59.3 ± 12.3 min.	15	Cotton swab under rhinoscopy	[34]
Costa	Cocaine	10%	1 ml	CH (NTG-induced)	Yes		15	Cotton swab under rhinoscopy	[34]
Blanda	Lidocaine	4%	1 ml	Migraine	Yes	The study was negative for the main outcome measure (decrease of ≥50% of initial pain score or an absolute pain score ≤ 2.5 cm at 5 min.	49	Barre	[29]
Windsor	Lidocaine	2%	1–2 ml	Herpes keratitis	No	Relief of pain in one case report	1	Applicator developed by the authors	[15]
Chae	Lidocaine	2%	N/S	Post-traumatic headache	No	Reduction of VAS scale within 15 min in both patients (from 8/10 to 0/10 in the first and from 10/10 to 2/10 in the second)	2	N/S	[41]
Cohen	Lidocaine	4%	N/S	Postdural puncture headache	No	Relief of pain in a series of patients	13	Applicator saturated	[42]
Bakbak	Lidocaine	10%	2 ml	CH	No	Relieve of pain and autonomic symptoms	1	Cotton-tipped applicator	[43]
Pfaffenrath	Lidocaine	6%	0,1 ml	Migraine	Yes	Primary endpoint not met: proportion of pain-free patients two hours after treatment. Improvement of several secondary endpoints.	140	Spray	[30]
Pfaffenrath	Ketorolac		0,1 ml	Migraine	Yes		140	Spray	[30]
Candido	Ropivacaine	0,5%	0,5 ml	1 TN, 1 CM, 1 post-herpetic neuralgia	No	All 3 patients reported pain relief within the first 15 min. Post-treatment.	3	Tx360®	[44]
Candido	Dexamethasone	–	–	1 TN, 1 CM, 1 post-herpetic neuralgia	No		3	Tx360®	[44]
Cady	Bupivacaine	0,5%	0,3 ml	Chronic migraine	Yes	Reduction of pain compared to placebo at 15 min, 30 min and 24 h compared to placebo (primary endpoint). Decreased HIT-6 score compared to placebo at 1 and 6 months.	38	Tx360®	[30]
Mohammadkarimi	Lidocaine	10%	1 puff	Acute headache	Yes	Significant reduction of mean pain scores at 1 min (primary endpoint). The effect was sustained at 30 min	90	Spray	[37]
Cohen	Lidocaine	5%	N/S	Postdural puncture headache	No	Relief of pain in a series of patients	32	Applicator saturated	[45]
Cady	Bupivacaine	0,5%	0,3 ml	Chronic migraine	Yes	Primary endpoint: statistically significant reduction of NRS scores. A comparison of the number of headache days during the baseline period and 1 month post-treatment was not significant.	38	Tx360®	[32]
Schaffer	Bupivacaine	0,5%	0,3 ml	Acute headache	Yes	Primary endpoint (50% reduction in pain at 15 min) negative.	93	Tx360®	[31]
Androlaukis	Bupivacaine	0,5%	0,6 ml	Hemicrania continua	No	Reduction in average intensity and frequency of headaches and autonomic symptoms.	1	Tx360®	[3]
Dance	Lidocaine	4%	N/S	Migraine (pediatric patients age 7–18)	No	Reduction of pain scores (only abstract available).	85	Allevio®	[46]

LA local anesthetic, SPF sphenopalatine foramen, RCT randomized clinical trial, CH cluster headache, N/S not specified, TN trigeminal neuralgia, CM chronic migraine, NTG nitroglycerine
^aBarre’s technique: the patient lies supine with extended neck (45 degrees) and head rotated 30 degrees ipsilateral to the pain. After the desired volume of anesthetic is applied, the patient should stay in the described position for 30 s. [3,4,5, 7, 12, 13, 15, 20, 26, 27, 29,30,31,32, 34, 37,38,39,40,41,42,43,44,45,46]

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