Trigeminal Nerve Block Periprocedural Care

Updated: Jul 06, 2016
  • Author: Anusha Cherian, MBBS, MD, DNB; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Periprocedural Care

Patient Education and Consent

Patients are asked not to eat or drink anything for 6 hours before the procedure. Except for anticoagulants and antiplatelet agents, routine drugs are allowed. Patients should be accompanied by a responsible adult.

The physician must explain the procedure, complications, and expected outcomes. Patients should be informed that a local anesthetic will be used to block the nerves causing the pain. They should be warned of possible facial numbness and weakness of facial muscles, especially decreased ability to chew (usually transient, resolving within 24 hours). They should understand that pain may recur after the drug wears off. They should notify the treating physician of the intensity of pain experienced and the amount of relief achieved during the block.

Patients should be made aware of potential side effects, the most common of which is swelling and bruising of the face. Rarely, some residual weakness of muscles or difficulty in breathing or swallowing can occur as a consequence of the involvement of other nerves. If these side effects arise, this must be communicated to the physician, and appropriate treatment must be administered. Patients may have to be kept under observation for at least 2 hours after the procedure.

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Equipment

Trigeminal nerve block should be performed only in a predesignated room that has the essential facilities for conducting the block safely and for resuscitating the patient in case of any major adverse events.

Necessary equipment includes the following:

  • 22-gauge long spinal needle (10 cm)
  • 5-mL syringe (for the block)
  • 1-mL syringe (for infiltration of skin)
  • Sterile drapes
  • Skin disinfectant – Alcohol, povidone-iodine, or chlorhexidine
  • Local anesthetic – Lidocaine or bupivacaine
  • Neurolytic agent – Alcohol, glycerol, or phenol
  • Sterile gloves
  • C-arm with fluoroscopy unit

This procedure must be done with appropriate monitoring in place. This may involve pulse oximetry, noninvasive blood pressure (NIBP) monitoring, electrocardiography (ECG), end-tidal carbon dioxide or respiratory rate monitoring, or a combination of 1 or more of these methods. Resuscitation drugs and equipment should be readily available.

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Patient Preparation

For trigeminal nerve block, the patient undergoes mild sedation with midazolam 0.5-1 mg or fentanyl 50-100 µg. Local anesthetics (eg, lidocaine 2% or bupivacaine 0.5%) may be used to provide temporary pain relief until the drug is metabolized.

The patient is placed in a supine position on an imaging table with an intravenous line in place and all monitors attached. The positioning of the head depends on the specific approach to the procedure (see Technique).

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