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Sphenopalatine Ganglion Block for the Treatment of Myofascial Pain of the Head, Neck, and Shoulders
  1. F. Michael Ferrante, M.D.,
  2. Andrew G. Kaufman, M.D.,
  3. Stuart A. Dunbar, M.D.,
  4. Charles F. Cain, M.D. and
  5. Suma Cherukuri, M.D.
  1. From the Pain Medicine Center, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pennsylvania.
  1. Reprint requests: F. Michael Ferrante, M.D., Director, Pain Medicine, Hospital of the University of Pennsylvania, 4th Floor, Ravdin Courtyard Building, 3400 Spruce Street, Philadelphia, PA 19104.


Background and Objectives This study examined the effectiveness of sphenopalatine ganglion block (SPGB) for myofascial pain syndrome of the head, neck, and shoulders using a double-blind, placebo-controlled, crossover study design with comparison to an internal standard consisting of trigger point injections (TPI).

Methods Patients (n = 23) were randomly assigned to receive either: (1) SPGB with 4% lidocaine, then TPI with 1% lidocaine, and finally SPGB with saline placebo or (2) SPGB with saline placebo, then TPI with 1% lidocaine, and finally SPGB with 4% lidocaine. Each respective treatment within each protocol was given sequentially at 1-week intervals for both groups. Prior to the first treatment, all patients assessed their average intensity of pain and pain at that particular moment using a visual analog pain scale. Pain intensity and pain relief were reassessed 30 minutes after each treatment and at 6 hours, 24 hours and 1 week using visual analog pain and pain relief scales. Pain intensity and pain relief data were transformed into natural logarithm units, and the statistical significance of SPGB with 4% lidocaine versus SPGB with placebo, SPGB with 4% lidocaine versus TPI, and TPI versus SPGB with placebo were tested by mixed-model analysis of variance. The magnitude of the differences in pain intensity and pain relief ratings were also compared via computation of 95% confidence intervals.

Results The analgesic effect of SPGB with 4% lidocaine was no better than placebo. Mixed-model analysis of variance revealed improved analgesia with administration of TPIs as compared to SPGB with 4% lidocaine and placebo over the entire week of observations (pain relief scores).

Conclusions This study suggests that SPGB with 4% lidocaine is no more efficacious than placebo and less efficacious than administration of standard trigger point injections in the treatment of myofascial pain of the head, neck, and shoulders.

  • sphenopalatine ganglion block
  • topical anesthesia
  • infiltration anesthesia
  • lidocaine
  • myofascial pain
  • trigger points.

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  • This study was presented in part at the 20th Annual Meeting of the American Society of Regional Anesthesia, Orlando, Florida, 1995.