Lignocaine for Sphenopalatine Block
Use 4% lignocaine (lidocaine) solution for sphenopalatine ganglion block, delivered intranasally via cotton-tipped applicators or atomization device.
Recommended Concentration and Delivery
- 4% lignocaine is the standard concentration for sphenopalatine ganglion block, as demonstrated in clinical trials and supported by airway anesthesia guidelines 1, 2
- The solution can be delivered via direct application under visualization or through noninvasive atomization devices 1, 2
- For intranasal delivery, approximately 0.3 mL per side (total 0.6 mL) is typically sufficient when using atomization 2
Alternative Concentrations
- 2% lignocaine gel can be used for nasal anesthesia and may be better tolerated than spray formulations with lower systemic absorption 3
- Some practitioners use concentrations ranging from 2-4% depending on the delivery method and desired depth of anesthesia 3
- Higher concentrations (4%) may provide more rapid onset of anesthesia, though lower concentrations can be equally effective 3
Maximum Dosing Considerations
- The maximum safe dose of topical lignocaine is 9 mg/kg lean body weight for airway procedures 3
- For a 70 kg patient, this translates to approximately 29 mL of 2% solution or 14.5 mL of 4% solution 3
- Calculate total dose carefully, especially if combining with other local anesthetic techniques (nerve blocks, infiltration) 3
- In elderly patients or those with hepatic/cardiac impairment, use extra caution and consider dose reduction 3
Clinical Application Technique
- Add a vasoconstrictor (phenylephrine 0.5%) to the lignocaine solution to reduce bleeding and systemic absorption 3
- Cocaine should be avoided due to cardiovascular toxicity risk without superior efficacy 3
- Test adequacy of block before proceeding with the procedure 3
Important Safety Considerations
- Have lipid emulsion and resuscitation equipment immediately available for potential local anesthetic systemic toxicity 3
- Monitor for signs of toxicity including perioral numbness, tinnitus, or altered mental status 3
- The research evidence for sphenopalatine blocks shows mixed efficacy, with one study showing no difference between 4% lidocaine and placebo for pain conditions 1, while another using bupivacaine showed benefit at 24 hours but not at 15 minutes 2