title: Management of isolated infraorbital neuralgia by ultrasound-guided infraorbital nerve block with combination of steroid and local anesthetic.
abstract: Patients with isolated peripheral branch neuralgia of trigeminal nerve usually receive traditional treatment such as medical therapy and interventional procedures targeting the entire trigeminal nerve or related ganglions. However, if the intractable pain is limited to a certain branch, the patient may also benefit from a peripheral and nerve-targeted interventional approach. Here, we report the management of a patient with isolated infraorbital neuralgia by ultrasound-guided infraorbital nerve block with steroid and local anesthetic combination. 48years-old male patient diagnosed with trigeminal neuralgia was resistant to medical therapy for 3years. The pain site was isolated to the area of the right nasal wing, right lateral incisor, the upper right canine and the first premolar teeth. His pain was an electric shock-like, throbbing and stabbing with a pain score of 8-9 according to numeric rating scale (NRS) and 18 according to the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS). Following a diagnostic ultrasound-guided infraorbital nerve block with 1% lidocaine, the block was repeated twice with 15mg lidocaine and 1.5mg dexamethasone in a total volume of 1.5mL in a month. The patient's NRS and LANSS scores decreased to 2 and 8, for approximately 21months until this report was written. We suggest that ultrasound-guided infraorbital nerve block with dexamethasone and lidocaine combination may present as an initial interventional treatment option in patients with isolated infraorbital neuralgia.
authors.affiliation: Department of Anesthesiology and Reanimation, Baskent University, Adana Education and Research Center, Adana, Turkey. Electronic address: oyacok01@yahoo.com.
authors.forename: Oya Y
authors.initials: OY
authors.lastname: Cok
authors.affiliation: Department of Radiology, Baskent University, Adana Education and Research Center, Adana, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Deniz
authors.affiliation: Department of Anesthesiology and Reanimation, Baskent University, Adana Education and Research Center, Adana, Turkey.
authors.forename: H Evren
authors.initials: HE
authors.lastname: Eker
authors.affiliation: Department of Radiology, Baskent University, Adana Education and Research Center, Adana, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Oguzkurt
authors.affiliation: Department of Anesthesiology and Reanimation, Baskent University, Adana Education and Research Center, Adana, Turkey.
authors.forename: Anis
authors.initials: A
authors.lastname: Aribogan
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009916:Orbital Diseases / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D014277:Trigeminal Neuralgia / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D003907:Dexamethasone; D008012:Lidocaine