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Antoun Nader - One of the best experts on this subject based on the ideXlab platform.

  • technical considerations for approaches to the ultrasound guided maxillary nerve block via the Pterygopalatine Fossa a literature review
    Regional Anesthesia and Pain Medicine, 2020
    Co-Authors: Ariana Anugerah, Kim Nguyen, Antoun Nader
    Abstract:

    Background and objectives Blockade of the trigeminal nerve and its branches is an effective diagnostic tool and potential treatment of facial pain. Ultrasound-guided injections in the Pterygopalatine Fossa (PPF) to block the trigeminal nerve divisions and sphenopalatine ganglion have been described but a consensus has yet to be reached over the ideal approach. We sought to delineate and compare the various approaches to the ultrasound-guided trigeminal divisions blockade via the PPF. Methods The literature search was performed by searching the National Library of Medicine’s PubMed database, the Cochrane Database of Systematic Reviews and Google Scholar within the date range of January 2009–March 2019 for keywords targeted toward “trigeminal nerve,” “maxillary nerve,” or “Pterygopalatine Fossa,” “ultrasound,” and “nerve block,” using an English language restriction. Six papers were included in the final review: one prospective double-blinded randomized controlled trial, one prospective descriptive study, one case series, two case reports, and one cadaveric study. Results There are three main approaches to the ultrasound-guided trigeminal nerve branches blockade via the PPF: anterior infrazygomatic in-plane, posterior infrazygomatic in-plane, and suprazygomatic out-of-plane approaches. Each showed injectate spread to the PPF in cadaver, adult and pediatric patients, respectively.1–5 Injectate used varied from 3 to 5 mL to 0.15 mL/kg. Conclusions These studies demonstrated that the PPF is a readily accessible target for the ultrasound-guided maxillary nerve block via three main approaches.2 The ideal approach is yet to be determined and must be further explored.

  • ultrasound guided pulsed radiofrequency application via the Pterygopalatine Fossa a practical approach to treat refractory trigeminal neuralgia
    Pain Physician, 2015
    Co-Authors: Antoun Nader, Bernard R Bendok, Jeremy J Prine, Mark C Kendall
    Abstract:

    Although pharmacological therapy is the primary treatment modality for trigeminal neuralgia associated pain, ineffective analgesia and dose limiting side effects often prompt patients to seek alternative pharmacological solutions such as interventional nerve blockade. Blockade of the Gasserian ganglion or its branches is an effective analgesic procedure for trigeminal neuralgia, traditionally performed using fluoroscopy or CT imaging. Ultrasonography allows point of care and real time visualization of needle placement within the surrounding anatomical structures. The use of ultrasonography with pulsed radiofrequency therapy for trigeminal neuralgia has not been reported. Our case is a 66-year-old male suffering from trigeminal neuralgia for 4 years that was refractory to pharmacologic therapy. Neurological examination was normal with no sensory deficit. Imaging showed no vascular compression or mass involving the trigeminal nerve. A diagnostic ultrasound-guided trigeminal nerve block via the Pterygopalatine Fossa with 4 mL of bupivacaine 0.25% and 4 mg dexamethasone provided immediate pain relief (100%) with sustained analgesia >50% at 2 weeks. Pain relief was not sustained at one month, with return to pretreatment symptoms. A series of injections were performed with similar intermittent analgesic effectiveness. The decision was made that the patient was a suitable candidate for pulsed radiofrequency application in the Pterygopalatine Fossa. We successfully used an alternative approach through the Pterygopalatine Fossa to treat trigeminal neuralgia using ultrasound guidance in an office setting. Our case demonstrates the utility of ultrasound-guidance pulsed radiofrequency treatment in the Pterygopalatine Fossa as a potential alternative to other percutaneous techniques for patients with medical refractory trigeminal neuralgia.

  • ultrasound guided trigeminal nerve block via the Pterygopalatine Fossa an effective treatment for trigeminal neuralgia and atypical facial pain
    Pain Physician, 2013
    Co-Authors: Antoun Nader, Mark C Kendall, Gildasio S De Oliveira, Jeffry Q Chen, Brooke Vanderby, Joshua M Rosenow, Bernard R Bendok
    Abstract:

    Background Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the Pterygopalatine Fossa in patients following refractory medical and surgical treatment. Objective To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the Pterygopalatine Fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Setting Academic pain management center. Study design Prospective case series. Methods Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the Pterygopalatine Fossa. Results All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Limitations Prospective case series. Conclusion We conclude that the use of ultrasound guidance for injectate delivery in the Pterygopalatine Fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions.

Bernard R Bendok - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound guided pulsed radiofrequency application via the Pterygopalatine Fossa a practical approach to treat refractory trigeminal neuralgia
    Pain Physician, 2015
    Co-Authors: Antoun Nader, Bernard R Bendok, Jeremy J Prine, Mark C Kendall
    Abstract:

    Although pharmacological therapy is the primary treatment modality for trigeminal neuralgia associated pain, ineffective analgesia and dose limiting side effects often prompt patients to seek alternative pharmacological solutions such as interventional nerve blockade. Blockade of the Gasserian ganglion or its branches is an effective analgesic procedure for trigeminal neuralgia, traditionally performed using fluoroscopy or CT imaging. Ultrasonography allows point of care and real time visualization of needle placement within the surrounding anatomical structures. The use of ultrasonography with pulsed radiofrequency therapy for trigeminal neuralgia has not been reported. Our case is a 66-year-old male suffering from trigeminal neuralgia for 4 years that was refractory to pharmacologic therapy. Neurological examination was normal with no sensory deficit. Imaging showed no vascular compression or mass involving the trigeminal nerve. A diagnostic ultrasound-guided trigeminal nerve block via the Pterygopalatine Fossa with 4 mL of bupivacaine 0.25% and 4 mg dexamethasone provided immediate pain relief (100%) with sustained analgesia >50% at 2 weeks. Pain relief was not sustained at one month, with return to pretreatment symptoms. A series of injections were performed with similar intermittent analgesic effectiveness. The decision was made that the patient was a suitable candidate for pulsed radiofrequency application in the Pterygopalatine Fossa. We successfully used an alternative approach through the Pterygopalatine Fossa to treat trigeminal neuralgia using ultrasound guidance in an office setting. Our case demonstrates the utility of ultrasound-guidance pulsed radiofrequency treatment in the Pterygopalatine Fossa as a potential alternative to other percutaneous techniques for patients with medical refractory trigeminal neuralgia.

  • ultrasound guided trigeminal nerve block via the Pterygopalatine Fossa an effective treatment for trigeminal neuralgia and atypical facial pain
    Pain Physician, 2013
    Co-Authors: Antoun Nader, Mark C Kendall, Gildasio S De Oliveira, Jeffry Q Chen, Brooke Vanderby, Joshua M Rosenow, Bernard R Bendok
    Abstract:

    Background Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the Pterygopalatine Fossa in patients following refractory medical and surgical treatment. Objective To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the Pterygopalatine Fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Setting Academic pain management center. Study design Prospective case series. Methods Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the Pterygopalatine Fossa. Results All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Limitations Prospective case series. Conclusion We conclude that the use of ultrasound guidance for injectate delivery in the Pterygopalatine Fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions.

Mark C Kendall - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound guided pulsed radiofrequency application via the Pterygopalatine Fossa a practical approach to treat refractory trigeminal neuralgia
    Pain Physician, 2015
    Co-Authors: Antoun Nader, Bernard R Bendok, Jeremy J Prine, Mark C Kendall
    Abstract:

    Although pharmacological therapy is the primary treatment modality for trigeminal neuralgia associated pain, ineffective analgesia and dose limiting side effects often prompt patients to seek alternative pharmacological solutions such as interventional nerve blockade. Blockade of the Gasserian ganglion or its branches is an effective analgesic procedure for trigeminal neuralgia, traditionally performed using fluoroscopy or CT imaging. Ultrasonography allows point of care and real time visualization of needle placement within the surrounding anatomical structures. The use of ultrasonography with pulsed radiofrequency therapy for trigeminal neuralgia has not been reported. Our case is a 66-year-old male suffering from trigeminal neuralgia for 4 years that was refractory to pharmacologic therapy. Neurological examination was normal with no sensory deficit. Imaging showed no vascular compression or mass involving the trigeminal nerve. A diagnostic ultrasound-guided trigeminal nerve block via the Pterygopalatine Fossa with 4 mL of bupivacaine 0.25% and 4 mg dexamethasone provided immediate pain relief (100%) with sustained analgesia >50% at 2 weeks. Pain relief was not sustained at one month, with return to pretreatment symptoms. A series of injections were performed with similar intermittent analgesic effectiveness. The decision was made that the patient was a suitable candidate for pulsed radiofrequency application in the Pterygopalatine Fossa. We successfully used an alternative approach through the Pterygopalatine Fossa to treat trigeminal neuralgia using ultrasound guidance in an office setting. Our case demonstrates the utility of ultrasound-guidance pulsed radiofrequency treatment in the Pterygopalatine Fossa as a potential alternative to other percutaneous techniques for patients with medical refractory trigeminal neuralgia.

  • ultrasound guided trigeminal nerve block via the Pterygopalatine Fossa an effective treatment for trigeminal neuralgia and atypical facial pain
    Pain Physician, 2013
    Co-Authors: Antoun Nader, Mark C Kendall, Gildasio S De Oliveira, Jeffry Q Chen, Brooke Vanderby, Joshua M Rosenow, Bernard R Bendok
    Abstract:

    Background Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the Pterygopalatine Fossa in patients following refractory medical and surgical treatment. Objective To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the Pterygopalatine Fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Setting Academic pain management center. Study design Prospective case series. Methods Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the Pterygopalatine Fossa. Results All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Limitations Prospective case series. Conclusion We conclude that the use of ultrasound guidance for injectate delivery in the Pterygopalatine Fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions.

Xisheng Xie - One of the best experts on this subject based on the ideXlab platform.

Emilio Gonzalezarnay - One of the best experts on this subject based on the ideXlab platform.