Ketamine Infusions for Trigeminal Neuralgia

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Groove

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Anybody else using ketamine for trigeminal neuralgia? I've been having great success with it.

About once a year I seem to get these extremely symptomatic TGN patients who have tried all sorts of medications and therapies with no effect and are desperate for pain relief. I'll do a ketamine infusion over 15-30 mins (0.3-0.4mg/kg) and it dramatically eradicates their symptoms 100%. I mean, totally gone. The pt's are incredibly grateful every time.

I was skeptical about ketamine infusions but actually learned the technique from a colleague of mine several years ago. He would have this pt that would check into the ER asking for him specifically every few months and request these infusions because it was the only thing that would work for him.

I had another last night and decided to try bolus therapy instead since there was a delay in getting the infusion set up. The bolus therapy worked also but wasn't as smooth as the infusion as the pt had some of that dissociative craziness going on after the sudden IV bolus but that rapidly resolved. I may try IM next time as an alternative to the infusion.

Try it out next time you have a TGN patient. I can't remember the original literature we reviewed all those years ago but I found this which is some more recent literature of the topic:

https://www.resetketamine.com/blog/2018/10/4/ketamine-treatments-for-trigeminal-neuralgia

It's become really satisfying for me as these pt's get almost instantaneous pain relief and are so grateful since nothing else has worked for them in the past.

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No.

But 0.4 mg / kg infused over 30 minutes seems safe. Very low side-effect profile.

At the end of the day, I get < 1 TN patient a year. So I'll probably forget this treatment the next time that pt comes in. :(
 
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I get 1 or 2 of these a year and have no good treatments, so will try it out. Occipital neuralgia is a lot easier to treat since you can just do a trigger injection of lido by ur hated that I didn’t have a decent analog in my TGN patients.
 
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Or just do a trigemminal nerve block. Easy, quicker and much less incentive for people to abuse


I love how the first line reads: Trigeminal ganglion blockade should be performed only by skilled and experienced interventionalists.

I can't say that I've done enough to be skilled and experienced in them.
 
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I love how the first line reads: Trigeminal ganglion blockade should be performed only by skilled and experienced interventionalists.

I can't say that I've done enough to be skilled and experienced in them.
I should clarify: I initially said Trigeminal nerve block. The link I posted is for trigeminal ganglion block (not EM appropriate). You're not going to put a needle through the foramen ovale in the ED and block the ganglion, with no training. I'll find a more appropriate link that shows the peripheral block with landmarks. Remember, your already blocking these nerve branches individually when many of your peripheral facial blocks. But you're right, to block the trigeminal ganglion (or gasserian ganglion) is very advanced interventional stuff and you don't want to go anywhere near that.
 
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Or just do a trigemminal nerve block. Easy, quicker and much less incentive for people to abuse


I stopped when I read this part:

"Aspiration should be performed first to check for CSF"


I'll stick to my ketamine infusions!
 
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I stopped when I read this part:

"Aspiration should be performed first to check for CSF"


I'll stick to my ketamine infusions!


Helluva way to get a CFP sample, right? lol:laugh:
 
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  • Wow
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