Transnasal sphenopalatine ganglion blockade for acute facial pain: a prospective randomized case-control study

OBJECTIVE: To evaluate the effectiveness of sphenopalatine ganglion blockade (SPGB) in the Emergency Medicine Department (EMD), simply performed using cotton-tipped applicators dipped in a mepivacaine 2% solution inserted along the turbinates, in patients with acute facial pain (AFP), including dental pain, and to compare the efficacy of SPGB with pharmacological treatment (PT). PATIENTS AND METHODS: A total of 89 consecutive patients [45 (50.6%) females, 44 (49.4%) males, median age 39 years, range 20-52 years] with AFP, mainly caused by toothache (N = 77, 86.5%), were randomly allocated into two groups, in accordance with the type of treatment: Group A (N = 44, cases) SPGB, and Group B (N = 45, controls) PT. Pain intensity (PI) was measured using a visual analogue scale (VAS) and the short-form of the McGill pain questionnaire (SF-MPQ). RESULTS: There was no correlation (r = 0.18, p = 0.92) between age and baseline PI, which did not differ (p = 0.471) between groups. PI reduction after treatment was significantly greater (p < 0.01) in Group A (SPGB), regardless of the evaluation method used (VAS or SF-MPQ). According to the multivariate regression analysis of variables, at 30 minutes both VAS (p = 0.001) and type of treatment (p = 0.011) reached significance, but at 60 minutes only type of treatment reached significance, so that the better results in pain reduction obtained in Group A patients can be justified only by the treatment (SPGB vs. PT). CONCLUSIONS: In patients with AFP, the SPGB was more effective than the PT, regardless of age and baseline PI and may be a new therapeutic option in the ED setting.