Trigeminal Nerve Blocks for Medically Intractable Painful Trigeminal Neuropathy

You-Chia Chen,1,2 Hsinlin Thomas Cheng2 1Department of Neurology, Cathay General Hospital, Taipei, Taiwan, Republic of China; 2Department of Neurology, Mass General Brigham, Harvard Medical School, Boston, MA, USACorrespondence: Hsinlin Thomas Cheng, Department of Neurology, Mass General Brigham, Harvard Medical School, WACC835, 15 Parkman Street, Boston, MA, 02114, USA, Tel +1 617 726 0240, Fax +1 617 726-6991, Email [email protected]: Painful trigeminal neuropathy (PTN) is a debilitating condition with persistent facial pain after a trigeminal nerve injury. It could be refractory to medication treatments and causes significant physical discomfort and psychological stress that significantly affects quality of life. This study aims to demonstrate the efficacy of trigeminal nerve blocks (TNB) for patients with PTN and to identify the parameters that affect treatment outcomes.Methods: In this retrospective chart review, we examined the medical records of 90 PTN patients who received trigeminal nerve blocks at Mass General Hospital (MGH) between March 2023 and March 2025. The trigeminal nerve blocks were performed using a variety of combinations of local anesthetics, from 2% lidocaine, 2% lidocaine plus 0.5% ropivacaine, to 4% lidocaine with 0.75% Bupivacaine. Triamcinolone was co-administered if no contraindication, including uncontrolled diabetes, hypertension, active infections, or psychological illness, existed.Results: The mean age was 50.6 years, and 71.1% of the participants were female. Seventy-three patients (81.1%) achieved ≥ 50% pain reduction. The duration of relief was: ≥ 6 weeks in 45 patients (50.0%), ≥ 8 weeks in 33 patients (36.7%), and ≥ 12 weeks in 21 patients (23.3%). Among the 33 patients with ≥ 8 weeks of relief, the effective regimens were: 2% lidocaine + triamcinolone (n=4, 12.1%), 2% lidocaine + 0.5% ropivacaine + triamcinolone (n=10, 30.3%), and 4% lidocaine + 0.75% bupivacaine + triamcinolone (n=13, 39.4%). The poor prognostic factors for treatment effects lasting shorter than 8 weeks include depression, involvement of the maxillary nerve (V2), and symptoms of facial numbness.Conclusion: The current study suggests that TNB with local anesthetics and steroids may be associated with better outcomes in patients with painful trigeminal neuropathy, based on this retrospective analysis.Keywords: facial pain, local anesthetics, triamcinolone, nerve injury, trigeminal neuropathy