ULTRASOUND-GUIDED sphenopalatine ganglion block (SPGB) is gaining traction as a minimally invasive option for allergic rhinitis (AR), a common chronic condition that markedly diminishes quality of life. A recent prospective, randomised, single-blind controlled trial evaluated the therapeutic effect of SPGB and whether adding dexamethasone improves outcomes beyond local anaesthetic alone.
From February to May 2024, eighty-four adults with AR were randomly assigned to weekly ultrasound-guided SPGB for four weeks, alternating sides; seventy-eight completed follow-up (40 experimental, 38 control). The experimental group received bupivacaine plus dexamethasone, while the control group received bupivacaine only. Outcomes spanned symptoms, quality of life and nasal airflow: Total Nasal Symptom Score (TNSS), a nasal symptom Visual Analogue Scale (VAS), the Rhino-conjunctivitis Quality of Life Questionnaire (RQLQ), Total Nasal Respiratory Volume (TNRV), Total Nasal Volume (TNV) and Total Nasal Resistance (TNR).
Both groups demonstrated significant improvements over pretreatment at every follow-up, one week, one month, three months and six months, across TNSS, VAS and RQLQ (P < 0.001). Short-term outcomes consistently favoured steroid augmentation: at one week, one month and three months the dexamethasone group achieved higher effective rates and lower TNSS, VAS and RQLQ scores than controls (P < 0.05). At six months, differences in effective rate, VAS and RQLQ were no longer significant (P > 0.05), although TNSS remained lower with dexamethasone (P < 0.05).
Objective airflow metrics mirrored these trends. TNRV and TNV increased, and TNR decreased, in both groups at all time points (P < 0.001). The dexamethasone group posted larger improvements, with significance at most visits, except for TNRV at six months and TNV at three and six months, where values converged. Safety indicators were comparable between groups (P > 0.05). Limitations included unmeasured mood symptoms and no 3D navigation.
Overall, ultrasound-guided SPGB is a safe and effective treatment for AR, and the addition of dexamethasone enhances short-term efficacy without compromising safety, supporting its considered adoption in routine care.
Reference
Luo Q, Fang J, Zhang Y, et al. Effects of Dexamethasone Administration in Sphenopalatine Ganglion Block for Allergic Rhinitis: A Prospective, Randomized, Single-blind Controlled Trial. Pain Physician. 2025;28(4):307-320.
