Ultrasound-guided sphenopalatine ganglion block for effective analgesia during awake fiberoptic nasotracheal intubation: A case report

Abstract

BACKGROUND Awake fiberoptic nasotracheal intubation (AFNI) is the preferred airway management strategy for patients with difficult airways. However, this procedure can cause significant physical and psychological distress. This case report explores the application of a sphenopalatine ganglion (SPG) block as an alternative analgesic modality to mitigate the discomfort associated with AFNI. CASE SUMMARY A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion. The patient’s medical history included prior surgery, chemotherapy, and radiation therapy, resulting in significant jaw impairment and limited neck mobility. Considering the anticipated airway challenges, AFNI was planned. A SPG block was performed under real-time ultrasound guidance, providing effective analgesia during nasotracheal intubation. CONCLUSION The SPG block represents a promising analgesic approach in AFNI, offering potential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.