Bradycardic Episodes of Trigeminocardiac Reflex During Fluoroscopy-Guided Ganglion Gasseri Radiofrequency Ablation in a Trigeminal Neuralgia Patient: A Case Report

Abstract

Background: Trigeminal neuralgia involves brief, sharp pain episodes triggered by light touch, speaking, or chewing. The Ganglion Gasseri block, a treatment for this pain, can cause the trigeminocardiac reflex (TCR), leading to severe bradycardia and temporary hypotension. This case report details a patient with left trigeminal neuralgia who experienced extreme bradycardia during the procedure and discusses the management of TCR to ensure patient safety and effective pain relief.

Case Illustration: A 55-year-old woman with hypertension and diabetes had trigeminal neuralgia, causing intense pain from her left jaw to her left lip, triggered by eating and talking. She underwent a ganglion Gasseri block but experienced severe bradycardia during the procedure, which was successfully managed with increased sedation. This bradycardia was identified as a trigeminocardiac reflex, a known complication during such procedures. Adequate sedation during the procedure is crucial to prevent vasovagal episodes that occur as a trigeminocardiac reflex. After the intervention, her pain significantly decreased, lowering her NRS from 7-8 to 2-3. At her follow-up visit 3 weeks after the intervention, she reported a marked improvement with no pain, she expressed satisfaction with the outcome, and she no longer needed daily pain medication. This case highlights the importance of recognizing and managing trigeminocardiac reflex to ensure patient safety.

Conclusion: This case illustrates the challenges of managing trigeminocardiac reflex (TCR) during pain procedures. A patient with trigeminal neuralgia, hypertension, and diabetes experienced severe bradycardia during a ganglion Gasseri block, requiring immediate intervention. Effective management of TCR ensured the patient's safety and led to significant pain relief. This case underscores the importance of careful monitoring, rapid response, and collaborative planning for patients with complex medical histories. It also highlights the critical role of adequate sedation during the procedure to prevent vasovagal episodes and ensure patient safety.