Comparison of Clinical Outcomes Trigeminal Nerve Block With and Without Radiofrequency Thermocoagulation for Trigeminal Neuralgia.

Background: Trigeminal neuralgia (TN) is known to be an excruciating disease. It leads to a reduced quality of life and psychological distress, often even to suicide. Patients who are intractable to pharmacotherapy should receive a percutaneous treatment, such as a trigeminal nerve block (TB) or radiofrequency thermocoagulation (RFT) of the trigeminal ganglion.

Objectives: The primary endpoint of this study was to compare the clinical outcome of TB alone with TB and RFT of the trigeminal ganglion.

Study design: Retrospective study.

Setting: The pain clinic of a tertiary university hospital.

Methods: Patients with TN received an ultrasound-guided supraorbital, infraorbital, or mental nerve block twice depending on the affected division. They were divided into TB only group (n = 42) and TBRF group (n = 60) depending on the result of the nerve block. The TBRF group, which had an unresponsive result to the initial nerve block, then received radiofrequency thermocoagulation (RFT) at the trigeminal ganglion.

Results: The Numeric Rating Scale (NRS-11), measured at 2 and 4 weeks post the initial nerve block, was significantly lower in the TB group than the TBRF group (P < 0.001). However, when RFT was performed in the TBRF group, the NRS-11 score became similar between the 2 groups (2.4 vs 2.05). Patients with a Barrow Neurological Institute (BNI) Pain Intensity Scale score of I or II, had a successful outcome: 45 patients in the TBRF group (45/60, 75%). Whereas, patients with a BNI score of IV or V, had an unsuccessful outcome: 6 patients (6/60, 10%) in the TBRF group. The time to recurrence in the TB and TBRF groups was 11.2 ± 1.6 and 19.4 ± 2.8 months, respectively (P = 0.01). The total recurrence rate at the 3-year follow-up in the TB and TBRF groups was 57% (24/42) and 23% (14/60), respectively (P = 0.001).

Limitation: Facial hypoesthesia is an important sign of successful destruction of the trigeminal ganglion. However, we did not analyze the BNI score according to the degree of facial hypoesthesia.

Conclusion: When patients with TN were unsuccessful with trigeminal nerve block alone, combining RFT at the trigeminal ganglion demonstrated a successful NRS-11 score reduction with a lower recurrence rate and a longer time to recurrence  than trigeminal nerve block alone.