Trigeminal (Gasserian) Ganglion Block Dr. S. Parthasarathy MD., DA., DNB, MD (Acu), Dip. Diab. DCA, Dip. Software statistics PhD (physio) Mahatma Gandhi medical college and research institute – puducherry, India

Indications Diagnostic for facial neuralgia Anaesthesia of surgery of the face Patients with severe underlying cardiopulmonary disease who require more than minor facial surgery 1 to 3 mL of local anesthetic

Anatomy The trigeminal ganglion is located intracranially and measures 1 × 2 cm. In its intracranial location, it lies lateral to the internal carotid artery and cavernous sinus and slightly posterior and superior to the foramen ovale, through which the mandibular nerve leaves the cranium

Anatomy- three divisions

Anatomy The trigeminal ganglion is partially contained within a reflection of dura mater, Meckel's cave. Three divisions Sensory , sensory, and partially motor

Position supine position Fixed gaze straight Anaesth . Stands by the side Clench teeth Identify medial border of masseter 3 cm lateral to corner of the mouth Sluijter-Mehta-Kanula cannula, 10 cm 22 G with a 2 mm active tip.

Technique Plane of zygoma and mandibular arch 10-cm needle is inserted Plane of pupil Aided by fluoroscopy sphenoid bone 4.5 – 6 cm Foramen ovale -6-7

Technique

technique

Fluoro

Another fluoro image

Technique Mandibular paresthesia- insufficient Some more insertion – elicit paresthesia in maxillary or ophthalmic area Aspirate - CSF – nil – 1 ml then wait for 5 minutes then give 1 ml No CSF 40 mg methylprednisolone, 4 mg dexamethasone, or 40 mg triamcinolone acetate – addition

TIPS Initially, the needle is directed downward and laterally. Then, the needle is aimed medially for the foramen ovale to avoid mouth entry. One finger should be placed in the mouth to prevent intraoral entry of the needle. Prophylactic antibiotics and sedation with midazolam and fentanyl are advised. 2-3 ml syringe

Radiofrequency generation of a pulsed electromagnetic field radiofrequency at 42°C for a 120-second cycle times two to three cycles. Standard radiofrequency neurolysis can also be performed at 67°C for 90 seconds. associated with a risk of sensory loss in the trigeminal nerve distribution.

Other techniques compression using a Fogarty-type balloon. More recently, surgical microvascular decompression and gamma knife irradiation of the nerve have been introduced.

Other drugs Alcohol Glycerol 6 % phenol With or without omnipaque Cryo

Complications CSF Vascular injury Painful procedure No time pressure

Other described complications Masticator muscle weakness, corneal analgesia, seizure, coma, keratitis, bacterial meningitis, carotid fistula, intracranial hemorrhage, diplopia, death, and facial or subscleral hematoma.

Thank you all The agony of pain is gone and the patient will smile like