Comparison of Transnasal Versus Ultrasound Guided Percutaneous Approach for Sphenopalatine Ganglion Block in Patients with Chronic Migraine

The study involves two groups of patients undergoing sphenopalatine ganglion (SPG) block after obtaining informed consent.

In Group 1, patients receive a transnasal SPG block in the supine position with mild neck extension. A long-tipped cotton applicator soaked with 0.5 ml of 2% lidocaine is advanced transnasally to the posterolateral surface of the nasopharynx at the level of the middle turbinate.

In Group 2, patients undergo an ultrasound-guided percutaneous SPG block under sterile conditions without sedation, using only local anesthesia. A high-frequency linear ultrasound probe (10–15 MHz) is placed transversely above the zygomatic arch and anterior to the temporal fossa to identify key landmarks, including the maxilla, zygomatic arch, temporal fossa, and the pterygopalatine fossa. Under real-time ultrasound guidance, a needle is advanced carefully, avoiding vascular structures, and hydrodissection may be performed to confirm precise tissue plane entry. Once non-vascular placement is confirmed, 1.5–3 ml of either 0.25–0.5% bupivacaine or 2%lidocaine with or without steroid, is injected to achieve blockade. All patients are monitored and followed up at one, two, and three months after the procedure.