Sphenopalatine ganglion block for postdural puncture headache: A review of current evidence

Table 1 Sphenopalatine ganglion blockade techniques

Technique	Ref.	Approach	Description	Key advantages	Key limitations/considerations
Trans nasal	Schaffer et al[13], 2015	Topical	A cotton-tipped applicator, catheter, or atomizer is used to apply a local anesthetic (e.g., lidocaine) to the nasal mucosa; an anesthetic is applied to the posterior pharyngeal wall mucosa; the goal is to diffuse the medication to the underlying sphenopalatine ganglion (SPG)	It is noninvasive and simple; quick to perform at the bedside; there is a low risk of serious complications; easily repeatable	Drug diffusion is inconsistent; shorter duration of the effect; the anesthetic dose is not precisely controlled; uncomfortable for patients
Transoral	Piagkou et al[11], 2012	Invasive	The needle is advanced through the hard palatine’s greater palatine foramen; the needle enters the pterygopalatine fossa; local anesthetic is injected directly into SPG; it is often performed under fluoroscopic guidance	This allows for the precise injection of a known volume; provides a more consistent and prolonged effect	Invasive: Risk of vascular injury and hematoma; risk of infection
Suprazygomati	Alseoudy et al[9], 2024	Invasive and ultrasound-guided	The needle is advanced superior to the zygomatic arch; the needle is guided to the pterygopalatine fossa to deliver anesthesia; the procedure is performed under real-time ultrasonographic guidance	Real-time visualization can improve the accuracy and safety of the procedure; it avoids radiation exposure	This requires significant ultrasound expertise and equipment; this is technically more challenging; risk of orbital injury
Infrazygomatic	Anthony Cometa et al[14], 2021	Invasive and fluoroscopy-guided	The needle is advanced inferior to the zygomatic arch through the masseter muscle; fluoroscopic imaging is used to guide the needle into the pterygopalatine fossa; imaging confirmed correct needle placement before anesthetic administration	Direct visualization of the needle position using fluoroscopy; it confirms accurate needle placement	It involves radiation exposure for both patients and operators; it is invasive and carries the risk of vascular injury and hematoma; it can damage the surrounding nerves

SPG: Sphenopalatine ganglion.