Sphenopalatine Ganglion Block to Treat Shoulder Pain During and/or After Cesarean

Shoulder pain thought to be caused by blood and amniotic fluid irritation of the diaphragm
and nerves that supply the shoulder, can occur during and/or after a cesarean. Investigators
will consent 100 patients, and will enroll 10 patients who develop ISP and have a score of is
>5/10 on the Verbal Analog pain Scale (VAS). Patients will be their own controls. Transnasal
SPG block will be performed after childbirth, and and beginning at 20 minutes post treatment,
the patient will be asked to rate their shoulder pain using the VAS a number of times.

Inclusion Criteria:

- Cesarean

- Presence of post-operative ISP, VAS >5/10

- American Society of Anesthesiologists Class 1 - 3.

- No allergy to lidocaine

Exclusion Criteria:

- American Society of Anesthesiologists Class 4 or 5.

- Allergy to lidocaine

- Nasal pathology (e.g., deviated septum)

- Patients who receive sedatives during cesarean

- Bleeding diathesis

- Any patient who the PI feels will be unable to comply with all protocol related
procedures

- Shoulder pain prior to cesarean