A Randomized, Dose-Finding Study of Sphenopalatine Ganglion Block With Bupivacaine for Emergency Department Patients With Headache.
Dane McCarthy, Lester Borrayes, Elyse Hopper et al.
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In 30 seconds
This randomized, four-arm study in two emergency departments assessed whether bupivacaine dose and unilateral versus bilateral transnasal sphenopalatine ganglion block (SPGB) affected sustained headache relief in patients with moderate or severe primary or secondary headache. Among 220 randomized patients, sustained relief occurred in 31% with 3 mL bilateral, 34% with 3 mL unilateral, 35% with 1 mL bilateral, and 19% with 1 mL unilateral SPGB. Neither 3 mL regimen produced more sustained relief than 1 mL unilateral SPGB; the authors concluded that larger doses did not improve this outcome.
Key findings
- Sustained relief rates were 31% (3 mL bilateral), 34% (3 mL unilateral), 35% (1 mL bilateral), and 19% (1 mL unilateral).
- Compared with 1 mL unilateral SPGB, neither 3 mL bilateral nor 3 mL unilateral SPGB resulted in more sustained relief.
- There were no statistically significant between-group differences in willingness to receive the same medication at a subsequent ED headache visit.
- Minor procedure-related adverse events were reported in ≤10% of participants in each arm.
Why it matters
The trial directly compared SPGB dose and laterality using a sustained-relief outcome that required improvement within 2 hours and relief for 48 hours without rescue analgesia. Its findings do not support an assumption that increasing bupivacaine volume improves sustained relief, while the reported tolerability provides relevant context for evaluating this procedure in emergency headache care.
What to keep in mind
Participants and investigators were not blinded, and there was no sham procedure. Most screened patients who declined participation preferred a nonnasal route, which may limit applicability to patients willing to receive transnasal treatment.