Intra-Oral Nerve Blocks for Trigeminal Neuralgia

  • Rahul Yadav
  • Siddharth Chavali


The management of drug-resistant trigeminal neuralgia (TGN) includes peripheral injections of different chemical agents into the affected nerve. Historically, chloroform was the first substance used for this purpose. Later on, substances like glycerol, phenol, boiling water, high concentrations of tetracaine [1], and streptomycin [2, 3] were also used. Alcohol injections [4] are preferred at the initial presentation of TGN or in elderly patients with similar problem [5]. Patients with significant medical co-morbidities who are not fit to undergo invasive surgeries safely, may also benefit from alcohol injection [5]. Peripheral alcohol nerve block is associated with a variable duration of pain relief ranging from 6 to 16 months [6]. There are two distinct techniques described for peripheral nerve blocks for TGN: (a) extra-oral or percutaneous nerve blocks and (b) intraoral nerve block; this chapter will focus on intraoral nerve block techniques involving mandibular and maxillary nerves, and their branches (Table 1). The preferred local anesthetic (LA) agents include lignocaine (1–2%) and bupivacaine (0.5%) with or without adrenaline (1:2,00,000). Currently, the use of ropivacaine (0.5%) has also been increased as it has minimal cardiovascular risks with a prolonged duration of action.


  1. 1.
    Mckenzie KG. The surgical treatment of trigeminal neuralgia. Can Med Assoc J. 1925;15:1119–24.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Gregg JM, Small EW. Surgical management of trigeminal pain with radiofrequency lesions of peripheral nerves. J Oral Maxillofac Surg. 1986;44:12225.CrossRefGoogle Scholar
  3. 3.
    Stajic Z, Juniper RP, Todorovic L. Peripheral streptomycin/lidocaine injections versus lidocaine alone in the treatment of idiopathic trigeminal neuralgia. A double blind controlled trial. J Craniomaxillofac Surg. 1990;18:243–6.CrossRefGoogle Scholar
  4. 4.
    Chindia ML, Ng’ang’a PM. Alcohol injection in the management of paroxysmal trigeminal neuralgia: a report of 6 cases. East Afr Med J. 1994;71:49–50.PubMedGoogle Scholar
  5. 5.
    Handerson WR. Trigeminal neuralgia: the pain and its treatments. Brit Med. 1967;1:7–15.CrossRefGoogle Scholar
  6. 6.
    Oturai AB, Jensen K, Erikson J, Marsden F. Neurosurgery for trigeminal neuralgia: comparison of alcohol block, neurectomy and radiofrequency coagulation. Clin J Pain. 1996;12:311–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Rahul Yadav
    • 1
  • Siddharth Chavali
    • 2
  1. 1.Oral and Maxillofacial Surgery, Centre for Dental Education and Research (CDER)All India Institute of Medical Sciences (AIIMS)New DelhiIndia
  2. 2.Department of Neuroanaesthesiology and Critical CareAll India Institute of Medical Sciences (AIIMS)New DelhiIndia

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