Long-term pain control in trigeminal neuralgia with local anesthetics using an indwelling catheter in the mandibular nerve.
OBJECTIVE
The authors sought to determine the usefulness of long-term continuous trigeminal nerve block with local anesthetics using an indwelling catheter in a patient with trigeminal neuralgia.


METHODS
The study design included pain control in a patient with trigeminal neuralgia until the time of neurosurgical operation.


METHODS
The study was conducted in the Dental Hospital of Tokyo Medical and Dental University.


METHODS
The patient was a 78-year-old woman with trigeminal neuralgia in the right maxillary region. Her pain could not be controlled by carbamazepine and was unbearable.


METHODS
The authors estimated the patient's pain intensity, quality, and locality using a visual analog scale to determine the effectiveness of continuous nerve block.


METHODS
Visual analog scores were measured during treatment. The treatment term was divided into three periods according to the difference of the catheter location and injection protocol (premandibular nerve block, infuser injection, and patient-controlled analgesia [PCA] pump injection). The authors also examined the patient's general condition and blood concentration of drugs.


RESULTS
The visual analog values were 44.8 +/- 3.6, 26.7 +/- 3.5, and 11.9 +/- 3.1 mm in each period, respectively. The value in the PCA pump infusion period was significantly lower than that in the other periods. No side effects of the local anesthetics were observed on the patient's systemic condition.


CONCLUSIONS
The authors controlled trigeminal neuralgia pain by blocking the mandibular nerve with local anesthetics administered through an indwelling catheter. Because the continuous nerve block with local anesthetics is reversible and only mildly toxic, this method is beneficial for pain control in patients with trigeminal neuralgia scheduled to undergo microvascular decompression.
Umino
Masahiro
M
Section of Anesthesiology and Clinical Physiology, Department of Oral Restitution, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. m.umino.anph@tmd.ac.jp
Kohase
Hikaru
H
Ideguchi
Shigeru
S
Sakurai
Norio
N
D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008340:Mandibular Nerve / Q000187:drug effects*; D009407:Nerve Block; D010147:Pain Measurement; D010148:Intractable Pain / Q000503:physiopathology / Q000628:therapy*; D010166:Palliative Care; D013997:Time Factors; D014277:Trigeminal Neuralgia / Q000503:physiopathology / Q000628:therapy*
D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine