Severe forms of trigeminal neuralgia (TN) that are resistant to pharmacological therapy and neurosurgical interventions (NSI) pose a major clinical challenge. Peripheral nerve blocks are an effective analgesic technique, making them a promising subject of investigation.

Objective. To determine the effectiveness of blocks using a mixture of lidocaine and betamethasone solutions (LID + β-M) in patients with severe TN and to assess the influence of various factors on treatment outcomes.

A total of 46 patients were examined (28 women — 60.87 %, 18 men — 39.13 %), aged 34–85 years (mean age 62.93 ± 11.98 years), with disease duration ranging from 1 to 38 years (mean 9.50 ± 9.90). In 88.27 % of cases, two or three branches of the trigeminal nerve were affected; 57.80 % had right-sided involvement. Neuralgic status (NS) was diagnosed in 32.61 % of patients. Indications for LID + β-M included ineffective pharmacotherapy, severe pain, refusal of or contraindications to other interventions, among others. Effectiveness was assessed based on changes in pain intensity using the VAS scale and clinical dynamics in short- and long-term periods. Within the first 24 hours, the mean effectiveness exceeded 60 %, with a gradual decline during the first month. Due to comorbidities or subsequent NSI, part of the cohort was excluded from long-term analysis; 5 patients (10.87 %) completed the study, all demonstrating 100 % effectiveness. A significant influence of age, sex, severity of pain syndrome (PS), TN duration, history of NSI, and complications on the dynamics of response to LID + β-M was identified. LID + β-M demonstrated superiority over lidocaine-only blocks and a potential short-term advantage over lidocaine blocks with methylprednisolone. The study shows that LID + β-M is an effective therapeutic method for severe TN, particularly in the short-term. The effectiveness of LID + BM depends on individual patient characteristics.