Objective:

Background:

TN is a debilitating facial pain disorder. TN flares present with high frequency severe attacks which can lead to dehydration and weight loss due to the fear of pain being triggered by eating and drinking. There are no randomized controlled trials on acute medical treatments. Infusions of fosphenytoin and other anti-seizure medications are commonly offered treatments which are not always enough to stop the attacks. SPG blocks, a minimally invasive intervention targeting the parasympathetic ganglion associated with cranial pain pathways, offer a promising easy alternative in outpatient settings.

Design/Methods:

Three patients (100% females, mean age 47 years) with confirmed TN who presented with flare unresponsive to standard treatments were included in this series. Each patient underwent bilateral SPG block with administration of viscous 2% lidocaine, delivered intranasally with a cotton tip applicator targeting the posterior middle nasal turbinate. The primary outcome was the reduction in pain intensity, measured on a 10-point scale before the procedure and at 10 minutes post-procedure. Secondary outcomes included patient-reported side effects and duration of response thereafter.

Results:

All three patients reported significant reductions in pain intensity immediately post-SPG block. Pain scores decreased by 83%, 75% and 40% at 10 minutes for each patient respectively, with sustained relief at least 48 hours after the procedure for 2 out of 3 patients. No serious adverse effects were reported. 

Conclusions: