Noninvasive Sphenopalatine Ganglion Block for Acute Headache in the Emergency Department: A Randomized Placebo-Controlled Trial

被引:42
作者
Schaffer, Jason T. [1 ]
Hunter, Benton R. [1 ]
Ball, Kevin M. [2 ]
Weaver, Christopher S. [1 ]
机构
[1] Dept Emergency Med, Indianapolis, IN 46202 USA
[2] Indiana Univ Sch Med, Indianapolis, IN 46202 USA
关键词
MIGRAINE; PROCHLORPERAZINE; DROPERIDOL; THERAPY; PAIN;
D O I
10.1016/j.annemergmed.2014.12.012
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Study objective: We seek to test the efficacy of noninvasive sphenopalatine ganglion block for the treatment of acute anterior headache in the emergency department (ED) using a novel noninvasive delivery device. Methods: We conducted a randomized, double-blind, placebo-controlled trial evaluating bupivacaine anesthesia of the sphenopalatine ganglion for acute anterior or global-based headache. This study was completed in 2 large academic EDs. Bupivacaine or normal saline solution was delivered intranasally (0.3 mL per side) with the Tx360 device. Pain and nausea were measured at 0, 5, and 15 minutes by a 100-mm visual analog scale. The primary endpoint was a 50% reduction in pain at 15 minutes. Telephone follow-up assessed 24-hour pain and nausea through a 0- to 10-point verbal scale and adverse effects. Results: The median reported baseline pain in the bupivacaine group was 80 mm (IQR 66 mm - 93 mm) and 78.5 mm (IQR 64 mm to 91.75 mm) in the normal saline solution group. A 50% reduction in pain was achieved in 48.8% of the bupivacaine group (20/41 patients) versus 41.3% in the normal saline solution group (19/46 patients), for an absolute risk difference of 7.5% (95% confidence interval [CI] -13% to 27.1%). As a secondary outcome, at 24 hours, more patients in the bupivacaine group were headache free (24.7% difference; 95% Cl 2.6% to 43.6%) and more were nausea free (16.9% difference; 95% Cl 0.8% to 32.5%). Conclusion: For patients with acute anterior headache, sphenopalatine ganglion block with the Tx360 device with bupivacaine did not result in a significant increase in the proportion of patients achieving a greater than or equal to 50% reduction in headache severity at 15 minutes compared with saline solution applied in the same manner.
引用
收藏
页码:503 / 510
页数:8
相关论文
共 23 条
[1]   Electrical Stimulation of Sphenopalatine Ganglion for Acute Treatment of Cluster Headaches [J].
Ansarinia, Mehdi ;
Rezai, Ali ;
Tepper, Stewart J. ;
Steiner, Charles P. ;
Stump, Jenna ;
Stanton-Hicks, Michael ;
Machado, Andre ;
Narouze, Samer .
HEADACHE, 2010, 50 (07) :1164-1174
[2]  
Candido KD, 2013, PAIN PHYSICIAN, V16, pE769
[3]   The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery [J].
Cho, Do-Yeon ;
Drover, David R. ;
Nekhendzy, Vladimir ;
Butwick, Alexander J. ;
Collins, Jeremy ;
Hwang, Peter H. .
INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY, 2011, 1 (03) :212-218
[4]   RANDOMIZED, PLACEBO-CONTROLLED EVALUATION OF PROCHLORPERAZINE VERSUS METOCLOPRAMIDE FOR EMERGENCY DEPARTMENT TREATMENT OF MIGRAINE HEADACHE [J].
COPPOLA, M ;
YEALY, DM ;
LEIBOLD, RA .
ANNALS OF EMERGENCY MEDICINE, 1995, 26 (05) :541-546
[5]   HEADACHE: THE PLACEBO EFFECTS IN THE CONTROL GROUPS IN RANDOMIZED CLINICAL TRIALS; AN ANALYSIS OF SYSTEMATIC REVIEWS [J].
de Groot, Femke M. ;
Voogt-Bode, Annieke ;
Passchier, Jan ;
Berger, Marjolein Y. ;
Koes, Bart W. ;
Verhagen, Arianne P. .
JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS, 2011, 34 (05) :297-305
[6]   Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after endoscopic sinus surgery [J].
DeMaria, Samuel, Jr. ;
Govindaraj, Satish ;
Chinosorvatana, Nina ;
Kang, Stanley ;
Levine, Adam I. .
AMERICAN JOURNAL OF RHINOLOGY & ALLERGY, 2012, 26 (01) :E23-E27
[7]   Drug therapy: Migraine - Current understanding and treatment. [J].
Goadsby, PJ ;
Lipton, RB ;
Ferrari, MD .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (04) :257-270
[8]   Headache in United States Emergency Departments: demographics, work-up and frequency of pathological diagnoses [J].
Goldstein, JN ;
Camargo, CA ;
Pelletier, AJ ;
Edlow, JA .
CEPHALALGIA, 2006, 26 (06) :684-690
[9]   Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support [J].
Harris, Paul A. ;
Taylor, Robert ;
Thielke, Robert ;
Payne, Jonathon ;
Gonzalez, Nathaniel ;
Conde, Jose G. .
JOURNAL OF BIOMEDICAL INFORMATICS, 2009, 42 (02) :377-381
[10]   RANDOMIZED DOUBLE-BLIND TRIAL OF INTRAVENOUS PROCHLORPERAZINE FOR THE TREATMENT OF ACUTE HEADACHE [J].
JONES, J ;
SKLAR, D ;
DOUGHERTY, J ;
WHITE, W .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1989, 261 (08) :1174-1176