Remifentanil: an attractive sedative for retrogasserian glycerol injection

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summaryIdiopathic trigeminal neuralgia is a very distressing pain pathology in the face. Retrogasserian infiltration of glycerol at Meckel's cave treating the affected trigeminal branch can immediately suppress pain for a variable duration of time. However, placing the needle is very painful and requires sedation, analgesia or anesthesia.The use of remifentanil anesthesia or sedation is to optimise patient's cooperation in finding cutaneous sensation differences by injecting glycerol towards the affected trigeminal branch. In doing so, we can minimize the use of glycerol, resulting in less nerve destruction and side effects. By optimising the patient's cooperation we can probably improve procedural safety and morbidity.A needle is placed through the foramen ovale by fluoroscopy in a sedated or anesthetized patient before injecting glycerol. To obtain hypo-algesia in the affected trigeminal branch, the patient must be well positioned. The degree of destruction in a selected part of the painful trigeminal branch is improved by full patient cooperation. This can easily be achieved using remifentanil until correct placement of the needle is achieved.We report our results using remifentanil sedation at a dose of 0.1–0.2 μg/kg/min in 3 patients. In comparison with propofol sedation, remifentanil makes patients much more alert and cooperative, resulting in a much better targeted injection than with propofol.

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