Pain Management
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Trigeminal nerve block is indicated for the following 
• Treatment of trigeminal neuralgia
• Diagnostic testing
• Post herpetic neuralgia
Trigeminal neuralgia is characterized by spontaneous, paroxysmal lancinating pain in the trigeminal nerve distribution. Often, the cause is not known. Occasionally, tumor infiltration, vascular compression of the nerve, or diseases such as multiple sclerosis may be the causative factors. Therefore, these patients should undergo complete neurologic evaluation.eminal nerve block is contraindicated for the following:
• Patients who refuse the procedure
• Patients who have coagulation abnormalities or are taking anticoagulant drugs
• Pregnant women
This procedure is performed under CT guidance /fluoroscopy .diagnostic block is given .after that only neurolytic block or radio frequency ablation is done.
Radiofrequency Ablation is a proceduRadiofrequency Ablation is a proceduRadiofrequency Ablation is a procedure which creates a nerve lesion produced by localized heat. When the lesion is placed over a painful nerve, pain signals are interrupted and pain perception by the brain is decreased. The procedure is performed in an outpatient setting. The treatment is done with local anesthesia along with IV sedation when needed. Before the procedure begins your physician starts by cleaning the skin over the injection site and injecting a local anesthetic to numb your skin. Another needle is placed through the numb tissue and the entire procedure is performed using fluoroscopic (X-ray) guidance. When the needle is in the correct location, an electrode is introduced into the center of the needle. Stimulation is initiated first with sensory stimulation and then with motor stimulation. When the correct needle position is verified, local anesthetic and sometimes a steroid medication are injected. Radiofrequency thermo-coagulation – The electrode is heated to 50-80°C and kept at that temperature for several minutes. Electro-thermal heat is generated, which allows for destruction of surrounding pain fibers, thereby decreasing your pain. Pulsed Radiofrequency – This technique is similar to thermo-coagulation RFA, but differs by a lower level of heat produced. This does not destroy the nerve tissue, but instead stuns the nerve. 
The success of a trigeminal nerve block depends on proper identification of the anatomic landmarks and the nerve itself. The duration of the block depends on the agent used. Local anesthetics typically provide analgesia lasting up to 12 hours, whereas neurolytic agents such as glycerol or alcohol have effects lasting for up to 6 months. Radiofrequency ablation has a 98% success rate and yields a longer pain-free period.