Sphenopalatine ganglion block: Intranasal transmucosal approach for anterior scalp blockade - A prospective randomized comparative study

Narmada Padhy, Srilata Moningi, Dilip K Kulkarni, Rajesh Alugolu, Srikanth Inturi, Gopinath Ramachandran, Narmada Padhy, Srilata Moningi, Dilip K Kulkarni, Rajesh Alugolu, Srikanth Inturi, Gopinath Ramachandran

Abstract

Background and aims: Peripheral nerve blocks in neurosurgical practice attenuate most stressful responses like pin insertion, skin, and dural incision. Scalp block is conventionally the blockade of choice. Further studies for less invasive techniques are required. Intranasal transmucosal block of the sphenopalatine ganglion has shown promising results in patients with chronic headache and facial pain. The primary objective of our study was to compare the gold standard scalp block and bilateral sphenopalatine ganglion block (nasal approach) for attenuation of hemodynamic response to pin insertion. Secondary objectives included hemodynamic response to skin and dural incision.

Material and methods: After IRB approval and informed consent, a prospective randomized comparative study was carried out on 50 adult patients undergoing elective supratentorial surgery. The hemodynamic response to pin insertion, skin incision, and dural incision was noted in both the groups. The data was analyzed with NCSS version 9.0 statistical software.

Results: The HR and MAP were comparable between the groups. Following dural incision MAP was significantly lower at 1,2,3,4,5 and 10 min in group SPG whereas in group S it was significantly lower at 1 and 2min. (P = 0.02 at T1, P = 0.03 at T2).

Conclusions: Concomitant use of bilateral SPG block with general anesthesia is an effective and safe alternative technique to scalp blockade for obtundation of hemodynamic responses due to noxious stimulus during craniotomy surgeries.

Keywords: Block; craniotomy; hemodynamics; neurosurgery; pain; scalp block; sphenopalatine ganglion.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2020 Journal of Anaesthesiology Clinical Pharmacology.

Figures

Figure 1
Figure 1
Hemodynamic parameters following pin insertion. SPG-sphenopalatine ganglion, HR-heart rate, PI-pin insertion, MAP-mean arterial pressure; T0-Baseline; T1-1 min; T2-2 mins; T3-3 mins; T4-4 mins; T5-5 mins; T10-10 mins
Figure 2
Figure 2
Hemodynamic parameters following skin incision. SPG-sphenopalatine ganglion, HR-heart rate, SI-skin incision, MAP-mean arterial pressure; T0-Baseline; T1-1 min; T2-2 mins; T3-3 mins; T4-4 mins; T5-5 mins; T10-10 mins
Figure 3
Figure 3
Hemodynamic parameters following dural incision. SPG-sphenopalatine ganglion, HR-heart rate, DI-dural incision, MAP-mean arterial pressure, T0-Baseline; T1-1 min; T2-2 mins; T3-3 mins; T4-4 mins; T5-5 mins; T10-10 mins

References

    1. Arshad A, Shamim MS, Waqas M, Enam H, Enam SA. How effective is the local anesthetic infiltration of pin sites prior to application of head clamps: A prospective observational cohort study of hemodynamic response in patients undergoing elective craniotomy. Surg Neurol Int. 2013;4:93.
    1. Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiology. 2000;93:48–54.
    1. Girard F. The management of intracranial hypertension in the perioperative period. J Crit Care. 23:174–80.
    1. Yoder J, Tempelhoff R. Hemodynamic complications after neurosurgery. In: Brabrink AM, Kirsch JR, editors. Essentials of Neurosurgical Anesthesia & Critical Care. New York: Springer; 2012. pp. 669–78.
    1. Rabelo NN, Silveira Filho LJ, dos Passos GS, Dias LA, Jr, Pereira CU, Dias LAA, et al. Acute arterial hypertension in patients undergoing neurosurgery. Arq Bras Neurocir. 2016;35:296–303.
    1. Tada Y, Wada K, Shimada K, Makino H, Liang EI, Murakami S, et al. Roles of hypertension in the rupture of intracranial aneurysms. Stroke. 2014;45:579–86.
    1. Vadivelu N, Kai AM, Tran D, Kodumudi G, Legler A, Ayrian E. Options for perioperative pain management in neurosurgery. J Pain Res. 2016;9:37–47.
    1. Guilfoyle MR, Helmy A, Duane D, Hutchinson PJ. Regional scalp block for postcraniotomy analgesia: A systematic review and meta-analysis. Anesth Analg. 2013;116:1093–102.
    1. Jayaram K, Srilata M, Kulkarni D, Ramachandran G. Regional anesthesia to scalp for craniotomy: Innovation with innervation. J Neurosurg Anesthesiol. 2016;28:32–7.
    1. Nair AS, Rayani BK. Sphenopalatine ganglion block for relieving postdural puncture headache: Technique and mechanism of action of block with a narrative review of efficacy. Korean J Pain. 2017;30:93–7.
    1. Schaffer JT, Hunter BR, Ball KM, Weaver CS. Noninvasive sphenopalatine ganglion block for acute headache in the emergency department: A randomized placebo-controlled trial. Ann Emerg Med. 2015;65:503–10.
    1. Ali AR, Sakr SA, Rahman ASM. Bilateral sphenopalatine ganglion block as adjuvant to general anaesthesia during enoscopic trans-nasal resection of pituitary adenoma. Egypt J Anaesth. 2010;26:273–80.
    1. DeMaria S, Govindaraj S, Chinosorvatana N, Kang S, Levine AI. Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after endoscopic sinus surgery. Am J Rhinol Allergy. 2012;26:e23–7.
    1. Faccenda KA, Finucane B. Complications of regional anaesthesia. Drug Saf. 2001;24:413–42.
    1. Kemp WJ, Tubbs RS, Cohen-Gadol AA. The innervation of the cranial dura mater: Neurosurgical case correlates and a review of the literature. World Neurosurg. 2012;78:505–10.
    1. Liu GT. The Trigeminal nerve and its central connections. In: Miller NR, Frank BW, William FH, editors. Walsh and Hoyt's Clinical Neuroophthalmology. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. pp. 1233–41.
    1. El Shazly MA. Endoscopic surgery of the vidian nerve: Preliminary report. Ann Otol Rhinol Laryngol. 1991;100:536–9.
    1. Bloomfield EL, Schubert A, Secic M, Barnett G, Shutway F, Ebrahim ZY. The influence of scalp infiltration with bupivacaine on hemodynamics and postoperative pain in adult patients undergoing craniotomy. Anesth Analg. 1998;87:579–82.
    1. Gazoni FM, Pouratian N, Nemergut EC. Effect of ropivacaine skull block on perioperative outcomes in patients with supratentorial brain tumors and comparison with remifentanil: A pilot study. J Neurosurg. 2008;109:44–9.
    1. Lee EJ, Lee MY, Shyr MH, Cheng JT, Toung TJ, Mirski MA, et al. Adjuvant bupivacaine scalp block facilitates stabilization of hemodynamics in patients undergoing craniotomy with general anesthesia: A preliminary report. J Clin Anesth. 2006;18:490–4.
    1. Rusu M. Microanatomy of the neural scaffold of the pterygopalatine fossa in humans: Trigeminovascular projections and trigeminal-autonomic plexuses. Folia Morphol. 2010;69:84–91.
    1. Candido KD, Massey ST, Sauer R, Darabad RR, Knezevic NN. A novel revision to the classical transnasal topical sphenopalatine ganglion block for the treatment of headache and facial pain. Pain Physician. 2013;16:E769–78.
    1. Robbins MS, Robertson CE, Kaplan E, Ailani J, Charleston L, Kuruvilla D, et al. The sphenopalatine ganglion: Anatomy, pathophysiology, and therapeutic targeting in headache. Headache. 2016;56:240–58.

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