Ultrasound-guided blockade of the second and third trigeminal branches in geriatric patients

Overview

This small clinical case series describes a technique of ultrasound-guided blockade of the second and third branches of the trigeminal nerve for facial surgery in geriatric patients.

Four geriatric patients (3 females and 1 male), average age of 74.5 years, were indicated for cancer surgery on the face at the Department of Surgery, Masaryk Hospital, in Ústi nad Labem. Anaesthesia of the second and third branches of the trigeminal nerve was performed by application of 8 ml 0.5% bupivacaine in the fossa pterygopalatina. The use of ultrasound allowed visualization of the trigeminal nerve branches, the maxillary artery and other vascular structures during the spread of the local anaesthetic. This reduced the likelihood of intravascular anaesthetic administration. The blockade was successful in all four patients without the need for conversion to general anaesthetic, patient complaints or discomfort. The patients were co-operating and breathing spontaneously under mild sedation. The cardiovascular stability was excellent despite the patients being considered high anaesthetic risk. The blockade of the second and third branches of the trigeminal nerve in the fossa pterygopalatina proved to be a simple technique suitable for facial surgery in geriatric patients.

Keywords:
ultrasound – the trigeminal nerve block