title: Endoscopic neural blockade for rhinogenic headache and facial pain: 2011 update.
abstract: BACKGROUND
  Over 45 million Americans suffer from recurrent headaches, and an estimated $11.9 million was spent on doctor's visits for rhinogenic pain last year. Sphenopalatine blocks have been described for various facial pain syndromes, but their use and the type of blockade agents remain controversial. The objective of this study was to demonstrate that endoscopic nerve blocks, using a mixture of bupivicaine and triamcinolone-40, injected into the anterior ethmoid or sphenopalatine regions, can be a relative safe and effective option for refractory pain.
  
  
  METHODS
  The charts of all patients undergoing endoscopic neural blockade, in a private practice setting from 1998 to 2008 were retrospectively reviewed. A 1:1 mixture of 0.5% bupivicaine and triamcinolone acetonide injectable suspension was injected into the patients' anterior ethmoid or sphenopalatine neural distribution, or both, depending on the pain distribution. Charts were reviewed to assess outcomes and any adverse events from nerve blocks.
  
  
  RESULTS
  A total of 882 nerve blocks were administered to 147 patients, over the course of 431 office visits. Four mild complications, 2 moderate complications, and no severe or permanent complications were noted. No permanent visual complications were observed. Of all the charts, 85% had documented effects of the nerve block at follow-up. Of those, 81.3% claimed improvement, 17.9% reported feeling the same, and 0.79% stated they had worse pain.
  
  
  CONCLUSIONS
  Endoscopic neural blockade appears to be a relatively safe and viable option in the treatment of refractory headache and facial pain with a rhinogenic component.
authors.affiliation: Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Regina
authors.initials: R
authors.lastname: Rodman
authors.forename: Jay
authors.initials: J
authors.lastname: Dutton
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage / Q000493:pharmacokinetics; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000493:pharmacokinetics; D002045:Bupivacaine / Q000008:administration & dosage / Q000493:pharmacokinetics; D004724:Endoscopy; D005005:Ethmoid Sinus / Q000187:drug effects* / Q000378:metabolism; D005157:Facial Pain / Q000188:drug therapy* / Q000209:etiology; D005240:Feasibility Studies; D006261:Headache / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D012008:Recurrence; D012189:Retrospective Studies; D012220:Rhinitis / Q000150:complications / Q000188:drug therapy*; D059387:Sphenopalatine Ganglion Block / Q000379:methods; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage / Q000493:pharmacokinetics
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D014221:Triamcinolone; D002045:Bupivacaine