title: The use of bupivacaine for blocking the Gasserian ganglion in major trigeminal neuralgia.
abstract: Five patients are reported with major trigeminal neuralgia in whom medicamentous therapy and/or peripheral blocking of the trigeminal nerve branches was unsuccessful in relieving pain attacks for appreciable periods. Under fluoroscopic control, 0.6 to 1.5 ml of a 0.5% bupivacaine solution (without added vasoconstrictor) was injected into the ganglion. In two patients with the cannula secured at its proper place, after 3 to 5 hours a second injection was given. Immediate complete anesthesia was induced in all patients in the whole innervation area of the trigeminal nerve. Conjunctival as well as corneal reflexed could not be stimulated. Sensibility returned after 24 to 72 hours, algesia being the function last restored; at this time, the eye reflexes were positive again. In spite of recovered sensibility, the patients remained free from typical paroxysmal attacks for several months or even years. Residual pain was easily combated by carbamazepine. Bupivacaine injections were well tolerated; no ill-effects of the drug were observed. In two patients disturbances were seen that are not uncommon after intrathecal injections.
mesh_terms: D000368:Aged; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D014276:Trigeminal Nerve / Q000187:drug effects; D014277:Trigeminal Neuralgia / Q000188:drug therapy*
chemical_list: D002045:Bupivacaine