Trigeminal Nerve Block For Non Acute Pain Patient information Leaflet February 2017 Please read this leaflet carefully. If you do not follow the instructions given your procedure may be cancelled
What is a Trigeminal Nerve Block? The trigeminal nerve is a nerve responsible for sensation in the face and certain motor functions such as biting, chewing, and swallowing. Irritation of this nerve causes an increase in the number of messages sent to the brain leading to pain. A Trigeminal Nerve block involves the injection of local anaesthetic medication and sometimes steroids into the area surrounding the Trigeminal nerve. This blocks the pain messages thereby reducing the amount of pain felt. The effect of the block is usually temporary, but the benefit can sometimes be prolonged. Your procedure will be performed under X-Ray guidance. If you are female please ensure there is no risk of you being pregnant on the day of your procedure. Please contact the Pain Nurse if you have any concerns. What Are The Benefits? Temporary relief of pain, however the longer the symptoms have been present, the less successful the outcome. Aid in diagnosis What are the possible side effects/complications of the procedure? All procedures in medicine carry a risk of complications. Precautions are always taken to minimize the risk as far as possible. Generally injections are safe but occasionally the following risks may occur: Failure of procedure to help Worsening of pain (Temporarily or permanently) Bleeding/ bruising to the injected area e.g. around the eyes Infection Hypotension/ low blood pressure Temporary numbness or paralysis of the tissue around the mouth and face. Allergic Reactions Dizziness/light headedness/fainting Roaring in the ears Nerve Damage Local anaesthetic toxicity (rare) fitting Potential side effects with using steroids If steroids are used there are few side effects associated with either single or occasional use of steroids. These include hot flushes, feeling sick, mild abdominal pain, fluid retention, raised blood sugar in diabetics and occasionally menstrual irregularities. These symptoms should settle in a few days. If you take water tablets (Diuretics) on a regular basis then please take an extra water tablet the day after your procedure. If you are diabetic you should closely observe your diabetic control for the next fortnight. Trigeminal Nerve Block for Non Acute Pain Patient Information Leaflet Page 2 of 8
Repeated and frequent use of steroids has the potential to lead to more serious effects but the doses of steroids given in the injections are small when compared with the doses of steroids taken by mouth on a regular basis. Are there any alternatives? A trigeminal nerve block is rarely a first line treatment and you may consider trying other approaches such as simple painkillers or acupuncture first. If you would like to discuss other alternatives please contact the nurse on the number provided within this leaflet. Prior to admission You must inform the Non Acute Pain Team at least 1 week prior to your procedure: 1. If you are allergic to local anaesthetic or steroid medication. 2. If you are or think you may be pregnant. 3. If you have an infection near the site of the injection or elsewhere. 4. If you are taking antibiotics or drugs used to treat infections eg Tamiflu; or have completed a course within the three weeks of your procedure date. 5. If you are taking blood thinning drugs such as: Warfarin, Sinthrome, Aspirin, Clopidogrel, Ticlopidinem, as it will be necessary to stop taking these medications prior to your procedure. You should consult the doctor who prescribed them to see if you can stop them temporarily to have this procedure. 6. If you are experiencing any difficulty or frequency in passing urine. 7. If you have had a vaccination (including the Flu Vaccine) or are planning to have a vaccination within one month of your appointment. 8. If you have had a heart attack within the last twelve months. 9. If you have undergone surgery or had an illness within four weeks of your procedure date. 10. If you do not have anyone to collect you and stay with you for 24 hours following discharge on the day of your procedure. Please note: If you are diabetic, please ensure that your HBA1C level has been checked within three months of your procedure date and you obtain a copy of the result, as the Pain Nurse will ask for this reading prior to confirming your procedure appointment. Trigeminal Nerve Block for Non Acute Pain Patient Information Leaflet Page 3 of 8
Please do not drive yourself to the hospital as you will not be able to drive home following your procedure. You must arrange for a responsible adult to collect you and take you home by car or taxi, and they must be able to stay with you overnight. If this is not possible your procedure may have to be postponed. How long will I be in hospital for? The procedure is performed as a day-case the time detailed on your appointment letter relates to your admission time your procedure will be carried out later that morning/afternoon. Please be prepared to stay approximately half a day, although you should bring your dressing gown, slippers and current medication with you in the event that you are required to stay in hospital overnight. On the day of your procedure Before Admission Please follow the starving instructions below: The day before your procedure: You should eat normally, but avoid large fatty meals NO alcohol for 24 hours before your procedure Fasting on the day of your procedure: Morning Procedure NO food after 2.30am, no chewing gum or boiled sweets after 2.30am NO smoking on the day of your admission You may have clear fluids (water, weak juice, black tea/coffee NO milk or milk products) up to 6am on the morning of your operation/procedure. Nothing by mouth after 6.30am on the day of procedure. Afternoon Procedure You may have a light breakfast (such as toast or continental breakfast, or a small bowl of cereal). NO food after 7.30am. You may have clear fluids (water, weak juice, black tea/coffee NO milk or milk products) up to 11.30am. Nothing by mouth after 11.30am on the day of procedure. Trigeminal Nerve Block for Non Acute Pain Patient Information Leaflet Page 4 of 8
Evening Procedure You may a eat light breakfast and light lunch up to 12.00 noon. NO food after 12.00 noon. You may have clear fluids (water, weak juice, black tea/coffee NO milk or milk products) up to 3.00pm. Nothing by mouth after 3.00pm on the day of procedure. If you are unwell on the day of your procedure please contact: The Non Acute Pain Secretary on 0161-922-6816 OR The Daycase Unit on: 0161-922-6219 What will happen to me before the procedure? On arrival to the unit, you will be asked to complete a pre-admission questionnaire, before being admitted by a nurse. During your admission the nurse will discuss the information provided in the questionnaire and record your pulse, blood pressure, respiratory rate, temperature and oxygen saturation (amount of oxygen in your blood), you may also be asked to provide a urine sample. If the information provided highlights a cause for concern or your observations are abnormal your procedure may be cancelled pending further investigation and treatment. Following admission you will be asked to return to the waiting area until your procedure time. Once you are called, the doctor will explain the procedure to you, and give you the opportunity to ask any questions. If you agree to have the procedure you will be asked to sign a consent form and and may be required to put on a gown. What will happen to me during the procedure? You will be asked to lie in a comfortable position on your back with a small support under your shoulders and a small needle may be inserted into the back of your hand. The procedure is performed under x-ray guidance, and involves an injection which is placed at either side of the face or close to the jaw. During placement of the needle, local anaesthetic is given to reduce the amount of discomfort you may feel. When the correct area has been identified, a further dose of local anaesthetic and possibly a steroid is given around one or more of the nerves causing your pain. What will happen to me after the procedure? You will be required to stay on the unit for around 30 minutes, during this time your observations will be recorded regularly. You may experience numbness, light headedness. These symptoms are to be expected and should settle within a couple of hours. You should therefore seek assistance from the nursing staff before having Trigeminal Nerve Block for Non Acute Pain Patient Information Leaflet Page 5 of 8
refreshments and you must not drink anything hot immediately after your procedure until the effect of the local anaesthetic has worn off. Where symptoms persist it may be necessary for you to stay in hospital overnight for observation. Please ensure you follow the instructions you are given about rest, exercise and how long to stay off work. Discharge Arrangements It is important that someone comes to collect you, and you do not attempt to drive yourself home. If you do not have anyone to escort you home, then you must discuss this with the pain team before the day of your procedure or your procedure will be cancelled. Once at Home On the day of the procedure make sure that you rest for the rest of the day. It is important that you monitor the effect of the injection on your pain, over the next couple of weeks as this will assist doctors in planning further treatment. If you have been given sedation it is important that in the following twenty four hours: You Do Not drive as your insurance will not cover you. You Do Not operate machinery (including cooking and using other domestic appliances). You Do Not drink alcohol. You Do Not make important decisions. You are Not left alone in the house to look after small children. Following your procedure an out patients appointment will be arranged in order for you to evaluate the effectiveness of treatment and discuss further management with the Non Acute Pain Team. If There Is A Problem If you have any concerns about anything relating to the appointment date or time please contact the Non Acute Pain Secretary. If you have any concerns relating to your procedure please contact the pain nurse. Contact Numbers: The Non Acute Pain Secretary can be contacted: Mon-Fri 9am-5pm on 0161-922-6816 The Non Acute Pain Nurse can be contacted on: Monday-Friday on 0161-922-6986 / 6759 N.B. Outside these hours leave a message and the secretary or the nurse will get back to you. However if the matter is urgent please contact your GP, NHS 111 or attend your local accident and emergency department. Trigeminal Nerve Block for Non Acute Pain Patient Information Leaflet Page 6 of 8
Other Useful Contacts or Information NHS 111 The Trusts Patient Information Centre 0161 922 5332 British Pain Society 020 7269 7840 / www.britishpainsociety.org/home Source of Good Practice W.B. Saunders (1999), Atlas of Regional Anaesthesia, 2 nd Ed., Philadelphia, USA If you have any questions you want to ask, you can use this space below to remind you. If you have a visual impairment this leaflet can be made available in bigger print or on audiotape. If you require either of these options please contact the Patient Information Centre on 0161 331 5332 Trigeminal Nerve Block for Non Acute Pain Patient Information Leaflet Page 7 of 8
Document control information Author: Jayne Grant, Clinical Nurse Specialist Pain Service Dr B. Ousta, Consultant Anaesthetist, Non Acute Pain Dr M. Ramay, Consultant Anaesthetist, Non Acute Pain Division/Department: Anaesthetic Department Date Created: November 2012 DATE REVIEWED February 2017 Reference Number: NAP 013 Version: 2.1 Trigeminal Nerve Block for Non Acute Pain Patient Information Leaflet Page 8 of 8