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 80% (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.
Key words: Trigeminal nerve, ultrasound-guided, atypical facial pain, trigeminal neuralgia, tic
douloureux.