Bilateral Sphenopalatine Ganglion Block Reduces Blood Pressure in Never Treated Patients With Essential Hypertension. A Randomized Controlled Single-Blinded Study

Triantafyllidi, Eleni; Arvaniti, Chrysa; Schoinas, Antonios; Benas, D; Vlachos, Stefanos; Palaiodimos, Leonidas; Pavlidis, George; Ikonomidis, Ignatios; Batistaki, Chrysanthi; Voumvourakis, Costas; Lekakis, John

doi:10.1097/01.hjh.0000539617.38382.64

Cited by 3 publications

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“…[33] In contrast, the blockade of the sympathetic neurons of the SPG can control blood pressure. In a clinical trial, [34] a decrease in blood pressure was found 1 month after SPG block with 2% lidocaine in the group of patients with an overactivated sympathetic nervous system, with no disturbances in cardiac conduction or heart rate. After injection of the SPG, our patient became normotensive with continuous values of 120/75 blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report

2022

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Background: Post COVID-19 syndrome (PC-19S) appears to be independent of acute illness severity and humoral response. The involvement of the autonomic nervous system (ANS), expressed by dysautonomia, has been hypothesized as a contributor. Several studies have associated the therapeutic effects of local anesthetics (LA) to their action on the ANS. To the best of our knowledge, this is the first report of therapeutic injections with LA linked to clinical improvement in a patient with PC-19S. Patient concerns and diagnoses: This was a 54-year-old-man with postCOVID-19 symptoms lasting 14 weeks, including fatigue, breathlessness, diarrhea, muscle pain, and emotional lability. Interventions and outcome: Injections of 0.5% procaine in the stellate ganglion (SG) and sphenopalatine ganglion (SPG), and in clinically relevant points in the scalp, thorax, and abdomen were performed 3 times over 3 months. The patient reported progressive improvement and was asymptomatic upon completing the treatment. Prescribed medications were discontinued. The 36-Item Short Form Health Survey (SF-36) score showed significant improvement across all SF-36-domains. Conclusion: Subanesthetic doses of LA injected in clinically relevant points led to rapid and complete symptom resolution in this patient with PC-19S. Targeted LA injections may have therapeutic benefits in PC-19S and in other chronic diseases linked to stress and inflammation.

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Section: Discussionmentioning

confidence: 99%

Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report

2022

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“…While the parasympathetic relationship to cardiovascular control has not been described, blockade of parasympathetic outflow related to vascular tone could also lead to uninhibited sympathetic stimulation. A counterpoint study by Triantafyllidi et al 14 describes bilateral SPG block to treat essential hypertension; however, the study has limits. The number of subjects was quite low, SPG blockade was via nasal cotton tip applicator, and a change of 5 mm•Hg was considered effective.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Sphenopalatine Ganglion Block With Liposomal Bupivacaine Followed by Severe Hypertension: A Case Report

et al. 2022

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We reviewed a case of bilateral sphenopalatine ganglion (SPG) blockade with liposomal bupivacaine for sinus surgery. The case was complicated by severe postoperative hypertension refractory to antihypertensives and needing intensive care unit (ICU) admission. While SPG blockade has been used to treat headaches and provide perioperative analgesia, this complication and a possible mechanism have not been described. We discuss how local anesthetic spread beyond the SPG may have caused prolonged parasympathetic blockade and hypertension. Before approved indications are established, we recommend avoiding the use of liposomal bupivacaine in off-label settings when the function of bilateral autonomic structures could be affected.

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“…Ruskin [2] reviewed the remote effects of blocking the PPG and reported its efficacy for headaches, facial neuralgias, low back pain, temporomandibular joint dysfunction, and even hiccups. Subsequently, the classic and modified techniques and related anatomy have been well documented in numerous clinical studies [3][4][5] and reviews [6,7]. Because of the anatomical complexity of the pterygopalatine fossa (PPF) and sphenopalatine foramen (SPF), depiction and clarification of the needle trajectory for PPG blockade has been challenging.…”

Section: Introductionmentioning

confidence: 99%

Clinical Anatomy of Blockade of the Pterygopalatine Ganglion: Literature Review and Pictorial Tour Using Cadaveric Images

et al. 2018

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Pterygopalatine ganglion block (sphenopalatine ganglion block) is a well-known procedure for treating cluster headache and for relieving cancer pain. In this review, the history and anatomy of the pterygopalatine ganglion are discussed, and images, including computed tomography and endoscopy, are presented to improve understanding of the clinical anatomy of the ganglion regarding the block procedure.

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Bilateral Sphenopalatine Ganglion Block Reduces Blood Pressure in Never Treated Patients With Essential Hypertension. A Randomized Controlled Single-Blinded Study

Cited by 3 publications

References 0 publications

Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report

Local anesthetics as a therapeutic tool for post COVID-19 patients: A case report

Bilateral Sphenopalatine Ganglion Block With Liposomal Bupivacaine Followed by Severe Hypertension: A Case Report

Clinical Anatomy of Blockade of the Pterygopalatine Ganglion: Literature Review and Pictorial Tour Using Cadaveric Images

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