Ultrasound-Guided Suprazygomatic Nerve Blocks to the Pterygopalatine Fossa: A Safe Procedure

Abstract

Objectives Large-scale procedural safety data on pterygopalatine fossa nerve blocks (PPFB) using a suprazygomatic, ultrasound-guided approach are lacking, leading to hesitancy surrounding this technique. The aim of this study was to characterize the safety of PPFB. Methods This retrospective chart review comprised adults who received an ultrasound-guided PPFB from 01/01/2016–08/30/2020 at the University of Florida. Indications included surgical procedures and non-surgical pain. Clinical data describing PPFB were extracted from medical records. Descriptive statistics were calculated for all variables, and quantitative variables were analyzed using the paired t-test to detect differences between pre- and post-procedure. Results A total of 833 distinct PPFBs were performed on 411 subjects (59% female, mean age 48.5 years). Minor oozing from the injection site was the only reported side effect in a single subject. While systolic blood pressure, heart rate and oxygen saturation were significantly different pre- and post-procedure (132.3 vs 136.4 mmHg, p < 0.0001; 78.2 vs 80.8, p = 0.0003; and 97.8% vs 96.3%, p < 0.0001 respectively), mean arterial pressure and diastolic blood pressure were not significantly different (96.2 vs 97.1, p = 0.1545; and 78.2 vs 77.4 mmHg, p = 0.1314 respectively). Similar results were found within subgroups, including sex, race, and indication for PPFB. Discussion We have not identified clinically significant adverse effects from PPFB using an ultrasound-guided suprazygomatic approach in a large cohort in the hospital setting. PPFBs are a safe and well-tolerated pain management strategy; however, prospective multicenter studies are needed.

Refractory primary and secondary headache disorders that dramatically responded to combined treatment of ultrasound-guided percutaneous suprazygomatic pterygopalatine ganglion blocks and non-invasive vagus nerve stimulation: a case series

“…1 He unsuccessfully treated the patients over at least 4 years with antihistamines, phenothiazines, H1-antagonists, methysergide, indomethacin, prednisone, propranolol, and lithium carbonate before the pterygopalatine ganglion (PPG) alcoholizations. Similar to more recent studies, 3 4 Devoghel found that the percutaneous suprazygomatic approach to the PPG is the simplest and safest technique, and he achieved a remarkable success rate of 85.8% of patients who went into apparent permanent remission. 1 While the etiopathogeneses of most secondary headaches are generally well understood, 5 that of primary headache disorders (PHDs) still eludes us.…”

Suprazygomatic Maxillary Nerve Blocks and Opioid Requirements in Pediatric Adenotonsillectomy

“…This delay can be attributed to educational efforts, additional time for procedural timeouts, and coordination between teams before and after the procedure. While the ultrasonography approach may only need minimal readily available equipment in pediatric operating rooms and can be done within 10 minutes, the alternative landmark SZMN block uses less than 2 minutes . Increases in operating room time may mean reserving this technique for subsets of patients that will have maximal benefit.…”

“…While the ultrasonography approach may only need minimal readily available equipment in pediatric operating rooms and can be done within 10 minutes, the alternative landmark SZMN block uses less than 2 minutes. 9,41,74 Increases in operating room time may mean reserving this technique for subsets of patients that will have maximal benefit.…”

Acute Headache Management for Patients with Subarachnoid Hemorrhage: An International Survey of Health Care Providers

“…were utilized at least occasionally by nearly one of ve respondents. While most published data on any of these treatments are based on case reports or smaller case series, experience with pterygopalatine fossa blocks, occipital nerve blocks and acupuncture have been reported with potentially promising results [15,16,40,41] and may offer potential additions to the multi-drug regimens that are most commonly employed. Providers considering such alternative strategies were more likely based in North Americalikely a re ection of the regional shift from opioid-based analgesia-and were more likely to be considered in a setting where the intensive care team was responsible for analgesia.…”

“…More recently, multimodal pharmacotherapy with agents such as gabapentinoids, magnesium infusions, corticosteroids, and utilization of nerve blocks have been reported [13][14][15][16].…”