Sphenopalatine Ganglion Block to Treat Shoulder Pain After Thoracotomy

This is an open label preliminary pilot study which will evaluate the utility of
sphenopalatine ganglion (SPG) block to manage ipsilateral shoulder pain (ISP). It will
determine if SPG block has potential utility to manage ISP in post-thoracotomy patients One
hundred (100) patients will initially be consented in this study. Patients have to develop
ISP and have a pain VAS >= 5. The study is seeking ten (10) eligible participants.

Patients will be followed after the SPG block(s), and the duration of pain relief will be
monitored by serial assessments of the VAS. This assessment will occur for the initial SPG
block and for all follow-up blocks, if performed. The follow-up assessments will only involve
having the patient rate the ISP using a verbal VAS; This will take less than a minute of
patients time. In addition, all patients will have PRN access to standard systemic analgesics
as routinely ordered by the surgical service Safety assessments will be performed on all
subjects. Blood pressure, heart rate and respiratory rate will be obtained every 15 minutes
after each SPG block for 90 minutes. Dr. Grant will monitor the subjects for 90 minutes after
each SPG block.

Inclusion Criteria:

- Any type of open thoracotomy or video-assisted thoracoscopic surgery (VATS)

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

- American Society of Anesthesiologists Class 1 - 4

- No allergy to lidocaine

Exclusion Criteria:

- American Society of Anesthesiologists Class 5

- Allergy to lidocaine

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

- Bleeding diathesis

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

- Shoulder pain prior to thoracotomy