Urgent care peripheral nerve blocks for refractory trigeminal neuralgia

Area of Science:

• Neurology
• Pain Management
• Urgent Care Medicine

Background:

• Refractory trigeminal neuralgia (TGN) poses a challenge after medication failure, often leading to urgent requests for potent therapies like opioids or surgery.
• Peripheral nerve blocks present a safe and minimally invasive option for pain management in TGN.
• Evaluating the efficacy of peripheral nerve blocks as an alternative to more invasive procedures is crucial.

Purpose of the Study:

• To evaluate the effectiveness of peripheral trigeminal nerve blocks in patients with intractable primary TGN who have not responded to conservative medical therapy.
• To assess the duration and quality of pain relief achieved through peripheral nerve blocks.

Main Methods:

• A retrospective case series of nine patients with intractable primary TGN treated in an urgent care setting over two years.
• Peripheral trigeminal nerve blocks were performed targeting the supraorbital, infraorbital, mental, and auriculotemporal nerves.
• Injections utilized a combination of bupivacaine and lidocaine.

Main Results:

• All nine patients experienced immediate pain relief exceeding 50%.
• Seven out of nine patients reported complete pain freedom or only mild paresthesia.
• Six patients achieved lasting pain relief ranging from 1 to 8 months, with some experiencing sustained pain reduction or complete pain freedom.

Conclusions:

• Peripheral trigeminal nerve blocks can provide rapid and sustained pain relief for patients with refractory TGN.
• This procedure is a viable therapeutic option in urgent care or emergency department settings for TGN management.
• Peripheral nerve blocks offer a safe alternative before considering opioids or more invasive ganglion-level interventions.