Trigeminal nerve block under the ultrasound control in the pain medicine
Keywords:trigeminal nerve block, trigeminal neuralgia, pain management, ultrasound
The leading clinical manifestation of trigeminal neuralgia is pain syndrome. Recently, an integrative biopsychosocial approach has been proposed in the study of pain. Trigeminal neuralgia is marked by a significant prevalence, often severe course, lack of sufficiently effective methods of treatment. The aim of the article was to introduce the technique of trigeminal nerve block under the ultrasound control. When the trigeminal nerve block is performed, the terminal sections of its three main branches are to be anesthetized. The maximum full and wide blockade can be achieved with the block of the Gasser's node, but performance of this procedure is complicated, requires a special qualification of a neurosurgeon and fluoroscopic control due to the complexity of the innervation of the head, the presence of mutually overlapping zones and commision. The most frequent indications for trigeminal nerve block are diagnostic, therapeutic and surgical blockades. It is recommened to consider the need for a combination of blocks, when anesthesia is planned. Double navigation with a neurostimulator is used for the accuracy of the needle positioning improvement. In this case, we expect a motor response from the masticatory muscle. Thus, the trigeminal nerve block under the ultrasound control can be used in the management of pain syndrome in trigeminal neuralgia.
Erohina LG. Licevye boli: nevralgiya trojnichnogo nerva i drugie formy prozopalgij (Facial pains: trigeminal neuralgia and other forms of prozopalgia). Moscow: Meditsina; 2005. (In Russian)
BLOM S. Trigeminal neuralgia: its treatment with a new anticonvulsant drug (G-32883). The Lancet [Internet]. Elsevier BV; 1962 Apr;279(7234):839–40. Available from: https://doi.org/10.1016/s0140-6736(62)91847-0
Rushworth RG, Smith SF. Trigeminal neuralgia and hemifacial spasm: treatment by microvascular decompression. Med J Aust. 1982 May 15;1(10):424-6.
Watson CP. Management issues of neuropathic trigeminal pain from a medical perspective. J Orofac Pain. 2004;18(4):366-73.
Suresh S, Bellig G. Regional Anesthesia in a Very Low-Birth-Weight Neonate for a Neurosurgical Procedure. Regional Anesthesia and Pain Medicine [Internet]. BMJ; 2004 Jan;29(1):58–9. Available from: https://doi.org/10.1097/00115550-200401000-00012
Suresh S, Wagner AM. Scalp Excisions: Getting “Ahead” of Pain. Pediatric Dermatology [Internet]. Wiley; 2001 Jan;18(1):74–6. Available from: https://doi.org/10.1046/j.1525-1470.2001.018001074.x
Dimitriou V, Iatrou C, Malefaki A, Pratsas C, Simopoulos C, Voyagis GS. Blockade of branches of the ophthalmic nerve in the management of acute attack of migraine. Middle East J Anaesthesiol. 2002 Jun;16(5):499-504.
Gain P, Thuret G, Chiquet C, Pascal J, Michaud P, Maugery J, et al. [Facial anesthetic blocks in the treatment of acute pain during ophthalmic zoster]. J Fr Ophtalmol. 2003 Jan;26(1):7-14.
Bosenberg AT. Blocks of the face and neck. Techniques in Regional Anesthesia and Pain Management [Internet]. Elsevier BV; 1999 Jul;3(3):196–203. Available from: https://doi.org/10.1016/s1084-208x(99)80044-5
BÖSENBERG AT, KIMBLE FW. Infraorbital nerve block in neonates for cleft lip repair: anatomical study and clinical application. British Journal of Anaesthesia [Internet]. Elsevier BV; 1995 May;74(5):506–8. Available from: https://doi.org/10.1093/bja/74.5.506
Prabhu KPK, Wig J, Grewal S. Bilateral infraorbital nerve block is superior to peri-incisional infiltration for analgesia after repair of cleft lip. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery [Internet]. Informa UK Limited; 1999 Jan;33(1):83–7. Available from: https://doi.org/10.1080/02844319950159668
Higashizawa T, Koga Y. Effect of infraorbital nerve block under general anesthesia on consumption of isoflurane and postoperative pain in endoscopic endonasal maxillary sinus surgery. Journal of Anesthesia [Internet]. Springer Science and Business Media LLC; 2001 Aug 1;15(3):136–8. Available from: https://doi.org/10.1007/s005400170014
MCADAM D, MURO K, SURESH S. The Use of Infraorbital Nerve Block for Postoperative Pain Control after Transsphenoidal Hypophysectomy. Regional Anesthesia and Pain Medicine [Internet]. BMJ; 2005 Nov;30(6):572–3. Available from: https://doi.org/10.1016/j.rapm.2005.07.192
Tsui BCH. Ultrasound imaging to localize foramina for superficial trigeminal nerve block. Canadian Journal of Anesthesia/Journal canadien d’anesthésie [Internet]. Springer Science and Business Media LLC; 2009 Jun 6;56(9):704–6. Available from: https://doi.org/10.1007/s12630-009-9129-3
MESNIL M, DADURE C, CAPTIER G, RAUX O, ROCHETTE A, CANAUD N, et al. A new approach for peri-operative analgesia of cleft palate repair in infants: the bilateral suprazygomatic maxillary nerve block. Pediatric Anesthesia [Internet]. Wiley; 2010 Apr;20(4):343–9. Available from: https://doi.org/10.1111/j.1460-9592.2010.03262.x
Han KR, Kim C, Chae YJ, Kim DW. Efficacy and safety of high concentration lidocaine for trigeminal nerve block in patients with trigeminal neuralgia. International Journal of Clinical Practice [Internet]. Wiley; 2007 Nov 23;62(2):248–54. Available from: https://doi.org/10.1111/j.1742-1241.2007.01568.x
Sola C, Raux O, Savath L, Macq C, Capdevila X, Dadure C. Ultrasound guidance characteristics and efficiency of suprazygomatic maxillary nerve blocks in infants: a descriptive prospective study. Pediatric Anesthesia [Internet]. Wiley; 2012 May 15;22(9):841–6. Available from: https://doi.org/10.1111/j.1460-9592.2012.03861.x
Giles WC, Iverson KC, King JD, Hill FC, Woody EA, Bouknight AL. Incision and Drainage Followed by Mattress Suture Repair of Auricular Hematoma. The Laryngoscope [Internet]. Wiley; 2007 Dec;117(12):2097–9. Available from: https://doi.org/10.1097/mlg.0b013e318145386c
Brown DJ, Jaffe JE, Henson JK. Advanced laceration management. Emerg Med Clin North Am. 2007 Feb;25(1):83-99.
Suresh S, Barcelona SL, Young NM, Seligman I, Heffner CL, Coté CJ. Postoperative Pain Relief in Children Undergoing Tympanomastoid Surgery: Is a Regional Block Better than Opioids? Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2002 Apr;94(4):859–62. Available from: https://doi.org/10.1097/00000539-200204000-00015
Cregg N, Conway F, Casey W. Analgesia after otoplasty: regional nerve blockade vs local anaesthetic infiltration of the ear. Canadian Journal of Anaesthesia [Internet]. Springer Science and Business Media LLC; 1996 Feb;43(2):141–7. Available from: https://doi.org/10.1007/bf03011255
Suresh S, Voronov P. Head and neck blocks in infants, children, and adolescents. Pediatric Anesthesia [Internet]. Wiley; 2011 Oct 19;22(1):81–7. Available from: https://doi.org/10.1111/j.1460-9592.2011.03701.x
Loukas M, El-Sedfy A, Tubbs RS, Louis RG, Wartmann CH, Curry B, et al. Identification of greater occipital nerve landmarks for the treatment of occipital neuralgia. Folia Morphol (Warsz). 2006 Nov;65(4):337-42.
Greher M, Moriggl B, Curatolo M, Kirchmair L, Eichenberger U. Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection. British Journal of Anaesthesia [Internet]. Elsevier BV; 2010 May;104(5):637–42. Available from: https://doi.org/10.1093/bja/aeq052
Pinosky ML, Patel S, Dorman BH, L. R, Fishman, Scott T, et al. The effect of bupivacaine skull block on the hemodynamic response to craniotomy. Southern Medical Journal [Internet]. Southern Medical Association; 1995 Oct;88:S11. Available from: https://doi.org/10.1097/00007611-199510001-00005
Nguyen A, Girard F, Boudreault D, Fugère F, Ruel M, Moumdjian R, et al. Scalp Nerve Blocks Decrease the Severity of Pain After Craniotomy. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2001 Nov;93(5):1272–6. Available from: https://doi.org/10.1097/00000539-200111000-00048
Bilotta F, Rosa G. “Anesthesia” for awake neurosurgery. Current Opinion in Anaesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2009 Oct;22(5):560–5. Available from: https://doi.org/10.1097/aco.0b013e3283302339
Sinha P, Koshy T, Gayatri P, Smitha V, Abraham M, Rathod R. Anesthesia for awake craniotomy: A retrospective study. Neurology India [Internet]. Medknow; 2007;55(4):376. Available from: https://doi.org/10.4103/0028-3886.33308
Kumar A, Banerjee A. Continuous Maxillary and Mandibular Nerve Block for Perioperative Pain Relief: The Excision of a Complicated Pleomorphic Adenoma. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2005 Nov;101(5):1531–2. Available from: https://doi.org/10.1213/01.ane.0000181332.74791.fc
Nader A, Kendall MC, De Oliveria GS, Chen JQ, Vanderby B, Rosenow JM, et al. Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: an effective treatment for trigeminal neuralgia and atypical facial pain. Pain Physician. 2013 Sep-Oct;16(5):E537-45.
Nader A, Bendok BR, Prine JJ, Kendall MC. Ultrasound-Guided Pulsed Radiofrequency Application via the Pterygopalatine Fossa: A Practical Approach to Treat Refractory Trigeminal Neuralgia. Pain Physician. 2015 May-Jun;18(3):E411-5.
Parate L, Tejesh C, Geetha C, Mohan CVR. Peripheral nerve stimulator-guided mandibular nerve block: A report of three cases. Saudi Journal of Anaesthesia [Internet]. Medknow; 2016;10(4):491. Available from: https://doi.org/10.4103/1658-354x.179126
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