Analgesia and Sedation during Percutaneous Radiofrequency Electrocoagulation for Trigeminal Neuralgia

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Abstract
PATIENT COMFORT DURING percutaneous radiofrequency electrocoagulation for trigeminal neuralgia provides better working conditions for the surgeon and makes the patient more willing to return if a second procedure is necessary. This study evaluates five different regimens for analgesia and sedation including the standard of fentanyl and droperidol (Group A) and four other regimens, each containing midazolam. In a sixth group, droperidol was assessed for its antiemetic effects. Patients were medicated as follows: Group B, low-dose midazolam (3.0 mg average); Group C, low-dose midazolam (2.5 mg average) and oral diazepam (7.5 mg average) just before the procedure; Group D, high-dose midazolam (5.5 mg average); and Group E, high-dose midazolam (5.1 mg average) and oral diazepam. Medications were titrated to induce mild sedation in Groups A, B, and C and heavier sedation in Groups D and E. All patients received fentanyl and small doses of intravenous methohexital just before the cannula penetrated the foramen ovale and before radiofrequency electrocoagulation. At least 2 weeks later, patients reported their level of discomfort during the procedure and their recollection of the procedure on a 0 to 10 scale. In another group of 96 patients, 1.25 mg of droperidol was given in addition to the medications described for Groups D and E. There was a statistically significant improvement in comfort in Groups C, D, and E and added amnesia in Groups D and E. Vomiting occurred in none of the patients medicated with droperidol and in 5 of 143 patients who did not receive droperidol. It is recommended that the regimen of either Group D or E be used and that droperidol be added.