Presented at the 2013 AAPM Annual Meeting « Back

Tx360™: A Non-invasive Technique for Sphenopalatine Ganglion Nerve Block in the Treatment of Trigeminal Neuralgia

Kenneth D. Candido, MD, kdcandido@yahoo.com¹, Ruben Sauer, MD², Lalida Chupatanakul, MD³, Nebojsa Nick Knezevic, MD PhD⁴, (1) Advocate Illinois Masonic Medical Center, Chicago, Illinois, (2) Chicago Anesthesia Pain Specialist, Chicago, Illinois, (3) Chicago Anesthesia Pain Specialist Research Department, Chicago, Illinois, (4) University of Illinois, Chicago, Illinois

Introduction: The sphenopalatine ganglion, located in the posterior part of the middle nasal turbinate, is involved in pain associated indirectly with trigeminal neuralgia (TN). Treatment can be done by using non-surgical (cotton-tip-applicator), and surgical procedures which could cause nerve damage and sensory loss. The purpose of this case series is to present a novel non-invasive treatment for sphenopalatine ganglion nerve block (SPGB). Material and Methods: After IRB approval, patients were evaluated for pain using a numeric rating scale (NRS), quality of life questionnaire, Patient Global Impression of Change (PGIC), and patient satisfaction. The Tx360™ Nasal Applicator with 1ml 0.5% Marcaine/1:200,000 epinephrine were used to perform SPGB. Pre-procedural evaluations were repeated 15 minutes, 30 minutes, and every week up to day 28 day post-procedure. Results: Three female patients, ages 15, 18 and 43 presented with TN. The average baseline NRS were 7, with improvement during the first 15 minutes an average of 2 on the NRS, which persist on the first day post-procedure. At the end of the 28 days the average daily increased pain was up to 4 on NRS. All three patients were completely satisfied, and the PGIC status was very much improved on average. One patient developed minimal bleeding from the nose on the first day which stopped spontaneously. Conclusions: SPGB with Tx360™ provided clinically significant pain relief with minimal complications. Pain increase during the 28 days follow-up may indicate the need for repeating the procedure. Long term studies are needed to assess the efficacy of this technique.

Funding: None