Fluoroscopy-Guided Trigeminal Ganglion Blockade with Lidocaine Shows Promising Pain Relief

BACKGROUND Percutaneous procedures including radiofrequency (RF) and glycerol rhizotomy and percutaneous ballon compression are safe and effective alternatives to microvascular decompression (MVD) for refractory trigeminal neuralgia. Although minimally invasive, these methods cause direct injury to the trigeminal ganglion and nerves. We report the largest series of a novel treatment for refractory trigeminal neuralgia with percutaneous fluoroscopy‐guided trigeminal ganglion blockade with bupivacaine lidocaine. Methods We included patients with medially refractory trigeminal neuralgia. Data on patient demographic, location and severity of the trigeminal neuralgia, block technique (electromyography [EMG] guided with blink reflex, 3D software guided and fluorography guided), type and dose of lidocaine, cerebrospinal fluid return, complications, time period to return to baseline severity, overall months of follow‐up, the need for another procedure, time period for another procedure and current pain scale was collected. Results Thirteen patients with refractory trigeminal neuralgia who underwent fluoroscopy‐guided lidocaine blockade at University of Missouri from September 2020 to January 2024 were analyzed; four underwent EMG‐guided, four 3D software‐guided and remainder underwent fluoroscopy‐guided blockade. Two patients were loss to follow‐up. In the remaining 11 patients, three patients had no pain resolution; two had relief after MVD and was one considering MVD at the last follow‐up. One patient had resolution with Botox injection, initiated with recurrence one month later. Seven (66%) patients had long‐term resolution ranging from 3 to 21 months. Conclusion Bupivacaine lidocaine blockade may provide complete pain relief in medically refractory trigeminal neuralgia and may be considered prior to RF and glycerol rhizotomy.