Efficacy of ultrasound-guided combined sphenopalatine and stellate ganglion block in the treatment of allergic rhinitis.

Background: Although ultrasound-guided nerve blocks have shown potential efficacy in the treatment of allergic rhinitis (AR), high-quality clinical evidence is limited. This retrospective study evaluated the efficacy and safety of ultrasound-guided combined sphenopalatine and stellate ganglion block in the treatment of patients with AR. Methods: In total, 61 patients with AR who received the combined blocks at the Ultrasound Medicine Center of Gansu Provincial Maternal and Child Health Hospital/Gansu Provincial Central Hospital from March 2022 to September 2024 were retrospectively included in this study. The patients were allocated to the intermittent group (group A) or persistent group (group B) based on the disease course; intermittent was defined as symptoms <4 days/week or for <4 consecutive weeks, and persistent was defined as symptoms ≥4 days/week and for ≥4 consecutive weeks. All the patients completed the nasal provocation test (NPT) and quality of life scale (QLS) before treatment, and at 1, 3, and 6 months after treatment. Blocks were performed under real-time ultrasound guidance using 10 mg of triamcinolone acetonide and 3 mL of lidocaine, diluted with normal saline to a total volume of 10 mL; each single session targeted the sphenopalatine ganglion on one side and the stellate ganglion on the contralateral side; injections were administered every other day. Between-group differences were assessed using independent-sample t-tests, within-group pre- and post-treatment differences were assessed using paired t-tests, and comparisons across time points were assessed by repeated-measures analysis of variance. A two-sided P value <0.05 was considered statistically significant. Results: Compared with the baseline, both groups showed significant improvements in terms of their NPT and QLS scores at 1, 3, and 6 months after treatment (all P<0.05). At each follow-up time point, the persistent group (group B) had lower NPT and QLS scores than the intermittent group (group A), indicating worse symptoms and quality of life; these between-group differences were statistically significant (P<0.05). The between-group difference in NPT scores was most pronounced at 3 months (P<0.05), while the between-group difference in QLS scores was significant at 1 month (P<0.05). No puncture-site infections, vascular injuries, or permanent nerve injuries were observed during treatment or follow-up. Some patients experienced transient adverse effects, including facial numbness, pain, hoarseness, ptosis, and dysphagia, which resolved spontaneously without residual disability or need for long-term treatment. Conclusions: In this single‑center retrospective cohort, ultrasound-guided combined sphenopalatine and stellate ganglion block effectively improved the symptoms of AR in the short- and mid-term after treatment and was generally well tolerated; however, the effect tended to diminish with longer follow-up. Given the retrospective, single-center nature of this study, large-scale prospective randomized controlled trials are needed to confirm the long-term efficacy of the treatment and to determine the optimal treatment protocol.