Keywords
trigeminal ganglion
facial pain
head and neck neoplasms
case reports
Abstract
Objectives: To evaluate the impact of chemical neurolysis with alcohol in the Gasserian ganglion in patients with refractory cancer-related facial pain, assessing its effect on pain reduction, opioid consumption, safety, and tolerability.
Materials and methods: A case series study was conducted in ten patients with recurrent or progressive head and neck neoplasms, treated between 2021 and 2023. A neurolytic block of the Gasserian ganglion was performed using 0.5 ml of absolute alcohol, preceded by a diagnostic block with 1 % lidocaine at the same dose and guided by CT with contrast medium. Pain scores on the visual analog scale (VAS) were analyzed before, immediately after, at 8 and 30 days post-procedure, along with opioid consumption measured in oral morphine equivalent daily dose (MEDD). Adverse effects and complications related to the procedure were also recorded.
Results: The mean age of patients was 62 ± 16.1 years. The average VAS decreased from 9.20 ± 1.14 before the procedure to 1.40 ± 1.90 immediately after, with values of 2.30 ± 2.71 at 8 days and 1.60 ± 1.67 at 30 days. The mean opioid consumption initially decreased (55 mg MEDD at baseline vs. 49 mg at 8 days) but increased to 58.4 mg at 30 days without requiring additional therapies. No severe complications were reported, and all patients experienced pain relief.
Conclusions: Chemical neurolysis of the Gasserian ganglion with alcohol is an effective and safe alternative for managing refractory cancer-related facial pain. Its application significantly reduces pain intensity, improves patients’ quality of life, and may contribute to decreasing opioid consumption. This study highlights the relevance of interventional procedures in addressing complex cancer pain, providing a valuable field of research for the scientific and clinical community, with potential for future studies in this area.
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