Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: An effective treatment for trigeminal neuralgia and atypical facial pain

Antoun Nader, Mark C. Kendall, Gildasio S. De Oliveira, Jeffry Q. Chen, Brooke Vanderby, Joshua M. Rosenow, Bernard Bendok

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. Objective: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Setting: Academic pain management center. Design: Prospective case series. Methods: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. Results: All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 8 % (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Limitations: Prospective case series. Conclusion: We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions.

Original languageEnglish (US)
Pages (from-to)537-545
Number of pages9
JournalPain Physician
Volume16
Issue number5
StatePublished - Sep 2013
Externally publishedYes

Fingerprint

Pterygopalatine Fossa
Trigeminal Neuralgia
Facial Pain
Trigeminal Nerve
Nerve Block
Local Anesthetics
Pain
Therapeutics
Analgesia
Injections
Steroids
Pain Clinics
Minimally Invasive Surgical Procedures
Pain Management
Pharmacology

Keywords

  • Atypical facial pain
  • Tic douloureux
  • Trigeminal nerve
  • Trigeminal neuralgia
  • Ultrasound-guided

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Nader, A., Kendall, M. C., De Oliveira, G. S., Chen, J. Q., Vanderby, B., Rosenow, J. M., & Bendok, B. (2013). Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: An effective treatment for trigeminal neuralgia and atypical facial pain. Pain Physician, 16(5), 537-545.

Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa : An effective treatment for trigeminal neuralgia and atypical facial pain. / Nader, Antoun; Kendall, Mark C.; De Oliveira, Gildasio S.; Chen, Jeffry Q.; Vanderby, Brooke; Rosenow, Joshua M.; Bendok, Bernard.

In: Pain Physician, Vol. 16, No. 5, 09.2013, p. 537-545.

Research output: Contribution to journalArticle

Nader, A, Kendall, MC, De Oliveira, GS, Chen, JQ, Vanderby, B, Rosenow, JM & Bendok, B 2013, 'Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: An effective treatment for trigeminal neuralgia and atypical facial pain', Pain Physician, vol. 16, no. 5, pp. 537-545.
Nader, Antoun ; Kendall, Mark C. ; De Oliveira, Gildasio S. ; Chen, Jeffry Q. ; Vanderby, Brooke ; Rosenow, Joshua M. ; Bendok, Bernard. / Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa : An effective treatment for trigeminal neuralgia and atypical facial pain. In: Pain Physician. 2013 ; Vol. 16, No. 5. pp. 537-545.
@article{73699c0137c1407dba9be04d5a6325a8,
title = "Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: An effective treatment for trigeminal neuralgia and atypical facial pain",
abstract = "Background: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. Objective: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Setting: Academic pain management center. Design: Prospective case series. Methods: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. Results: All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 8 {\%} (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Limitations: Prospective case series. Conclusion: We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions.",
keywords = "Atypical facial pain, Tic douloureux, Trigeminal nerve, Trigeminal neuralgia, Ultrasound-guided",
author = "Antoun Nader and Kendall, {Mark C.} and {De Oliveira}, {Gildasio S.} and Chen, {Jeffry Q.} and Brooke Vanderby and Rosenow, {Joshua M.} and Bernard Bendok",
year = "2013",
month = "9",
language = "English (US)",
volume = "16",
pages = "537--545",
journal = "Pain Physician",
issn = "1533-3159",
publisher = "Association of Pain Management Anesthesiologists",
number = "5",

}

TY - JOUR

T1 - Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa

T2 - An effective treatment for trigeminal neuralgia and atypical facial pain

AU - Nader, Antoun

AU - Kendall, Mark C.

AU - De Oliveira, Gildasio S.

AU - Chen, Jeffry Q.

AU - Vanderby, Brooke

AU - Rosenow, Joshua M.

AU - Bendok, Bernard

PY - 2013/9

Y1 - 2013/9

N2 - Background: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. Objective: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Setting: Academic pain management center. Design: Prospective case series. Methods: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. Results: All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 8 % (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Limitations: Prospective case series. Conclusion: We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions.

AB - Background: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. Objective: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Setting: Academic pain management center. Design: Prospective case series. Methods: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. Results: All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 8 % (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Limitations: Prospective case series. Conclusion: We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions.

KW - Atypical facial pain

KW - Tic douloureux

KW - Trigeminal nerve

KW - Trigeminal neuralgia

KW - Ultrasound-guided

UR - http://www.scopus.com/inward/record.url?scp=84884697162&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84884697162&partnerID=8YFLogxK

M3 - Article

C2 - 24077204

AN - SCOPUS:84884697162

VL - 16

SP - 537

EP - 545

JO - Pain Physician

JF - Pain Physician

SN - 1533-3159

IS - 5

ER -