Transnasal Sphenopalatine Ganglion Block

The patient is placed in the supine position with the neck extended. The distance from the opening of the nares to the mandibular notch is measured to estimate the depth of needed cotton-tipped applicator advancement. The cotton-tipped applicator is soaked in 2% lidocaine gel and advanced into the nares parallel to the zygoma, with the tip angled laterally until it lays on the nasopharyngeal mucosa posterior to the midline nasal turbinate. The applicator is advanced along the superior border of the midline nasopharyngeal wall until resistance is met. The applicator is left for 10-15 minutes to achieve mucosal anesthesia. A Laryngojet device with 4% lidocaine can be inserted along the same angle as the cotton-tipped applicator. The 4% lidocaine is slowly injected and left for 10-15 minutes to achieve mucosal anesthesia in any areas that the lidocaine soaked cotton-tipped applicator failed to reach.

The sphenopalatine ganglion is a parasympathetic ganglion located within the pterygopalatine fossa that contributes to pain transmission through connections with the trigeminal nerve. SPG blockade has been used to treat a variety of headache and facial pain disorders, including post-dural puncture headache, cluster headache, and trigeminal neuralgia. The transnasal topical approach is the simplest method of accessing the ganglion, requiring a short procedural time while avoiding more invasive techniques.

Contraindications include patient or parent refusal, allergy to local anesthetics, active nasal or sinus infection, nasal fractures, coagulopathy or antithrombotic therapy, and pre-existing neurological deficits in the distribution of the block.

Medicaiton:
4% Lidocaine
2% Lidocaine gel

Equipment:
Sterile cotton-tipped applicator
Laryngojet device
Sterile gloves

The patient is placed in the supine position with the neck extended.

Preoperative workup includes evaluation for risk of anesthesia.

The sphenopalatine ganglion is a parasympathetic ganglion providing secretomotor function to the nasal, oral, and pharyngeal mucus membranes, the lacrimal glands, and branches to the meningeal and cerebral blood vessels. It carries pain signals from the trigeminal nerve, contributing to headaches, neuralgia, and facial pain syndromes. The SPG is located within the pterygopalatine fossa (PPF) - a cone shaped space located between the infratemporal fossa and nasopharynx. The PPF is bounded by the maxilla, palatine, and sphenoid bones and contains the maxillary nerve, maxillary artery, and pterygopalatine ganglion.

Complications, though uncommon, may include bleeding, infection, and cranial nerve palsies.

No conflicts to disclose

Dua, A., & Gillespie, E. (2026, January). Sphenopalatine Ganglion Block. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK557751/

LTA Tip Breaks in Patient's Airway - Anesthesia Patient Safety Foundation. (2018, October 1). Anesthesia Patient Safety Foundation (APSF). Retrieved April 27, 2026, from https://www.apsf.org/article/lta-tip-breaks-in-patients-airway/

Sphenopalatine Ganglion Block via the Transnasal Approach. (2019, February 1). Anesthesia Key. Retrieved July 29, 2026, from https://aneskey.com/sphenopalatine-ganglion-block-via-the-transnasal-approach/

Malinowski, M.N., Bremer, N.J. (2019). Sphenopalatine Ganglion Block. In: Deer, T., Pope, J., Lamer, T., Provenzano, D. (eds) Deer's Treatment of Pain. Springer, Cham. https://doi.org/10.1007/978-3-030-12281-2_64

Robbins, M. S., Robertson, C. E., Kaplan, E., Aliani, J., Charleston IV, L., Kuruvilla, D., Blumenfeld, A., Berliner, R., Rosen, N., Duarte, R., Vidwan, J., Halker, R., Gill, N., & Ashkenazi, A. (2015). The Sphenopalatine Ganglion: Anatomy, Pathophysiology, and Therapeutic Targeting in Headache. Headache: The Journal of Head and Face Pain. https://doi.org/10.1111/head.12729Digital Object Identifier (DOI)