ГоловнаArchive of numbers2024Volume 32, issue 3 (120)Effectiveness of lidocaine blockades in patients with severe forms of trigeminal neuralgia
Title of the article Effectiveness of lidocaine blockades in patients with severe forms of trigeminal neuralgia
Authors Posokhov Mykola
In the section MECHANISMS OF FORMATION AND MODERN PRINCIPLES OF TREATMENT OF NEUROLOGICAL DISORDERS
Year 2024 Issue Volume 32, issue 3 (120) Pages 4-13
Type of article Scientific article Index UDK 616.833.15-009.7-089 Index BBK -
Abstract DOI: https://doi.org/10.36927/2079-0325-V32-is3-2024-1

 The purpose of the present work was to study the effectiveness of lidocaine blockades (LB) in patients with severe forms of the trigeminal neuralgia (TN) in the close and long-term perspective. We analyzed the results of treatment of 45 patients (15 men and 30 women) with severe forms of TN using peripheral branch blockadess with 2 % lidocaine solution, which were performed according to the commonly accepted method. The age of patients ranged from 34 to 88 years (mean ± SD — 63,69 ± 12,31). All patients were referred to a neurosurgical clinic due to the ineffectiveness of previous drug therapy. The effectiveness was estimated at different periods after applied blockades using visual and analog rating scales at different times: at hospitalization (before the blockade started), in 30 minutes, in six hours, in one day (24 hours), in three days, in one month, in three months, in six months, in one year, in two years, and in three years after the blockades. LB of peripheral branches of trigeminal nerve in patients with severe pharmacoresistant forms of TN appeared to be effective in 100.00 % of patients in the first 3—6 hours after the implementation. Subsequently, the analgesic effect of NB is decreasing, especially in the coming weeks, that necessitated the use of more radical methods of neurosurgical treatment. Excellent long-term (after 2—3 years) results after the use of blockades on the background of adequately selected pathogenetic therapy of both the main and concomitant diseases of the nervous system and internal organs were achieved in 4 (8.89 %) of 45 patients. Thus, we can conclude that in case of ineffectiveness of conservative drug therapy, using of LB of the peripheral branches of trigeminal nerve is advisable within the complex treatment of patients with TN.
Key words trigeminal neuralgia, drug denervation, lidocaine blockade
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Bibliography 1. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. Jan;38(1):1- 211. doi: 10.1177/0333102417738202. PMID: 29368949.
2. Bendtsen L, Zakrzewska JM, Abbott J, Braschinsky M, Di Stefano G, Donnet A, Eide PK, Leal PRL, Maarbjerg S, May A, Nurmikko T, Obermann M, Jensen TS, Cruccu G. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019 Jun; 26(6):831-849. doi: 10.1111/ene.13950. Epub 2019 Apr 8. PMID: 30860637.
3. Cruccu Giorgio, Di Stefano Giulia and Truini Andrea. Trigeminal Neuralgia. N Engl J Med 2020;383:754-62. DOI: 10.1056/ NEJMra1914484.
4. Stavropoulou E, Argyra E, Zis P, Vadalouca A, Siafaka I. The Effect of Intravenous Lidocaine on Trigeminal Neuralgia: A Randomized Double Blind Placebo Controlled Trial. ISRN Pain. 2014 Mar 10;2014:853826. doi: 10.1155/2014/853826. PMID: 27335883; PMCID: PMC4893393.
5. Seo HJ, Park CK, Choi MK, Ryu J, Park BJ. Clinical Outcome of Percutaneous Trigeminal Nerve Block in Elderly Patients in Outpatient Clinics. J Korean Neurosurg Soc. 2020 Nov;63(6):814- 820. doi: 10.3340/jkns.2020.0139. Epub 2020 Oct 27. PMID: 33105531; PMCID: PMC7671772.
6. Bingül ES, Canbaz M, Güzel M, Şalvız EA, Akalın BE, Berköz Ö, Emre Demirel E, Sungur Z, Savran Karadeniz M. Comparing the clinical features of lateral and medial approaches of costoclavicular technique versus traditional lateral sagittal technique as infraclavicular brachial plexus block methods: a randomized controlled trial. BMC Anesthesiol. 2024 Jul 25;24(1):254. doi: 10.1186/s12871-024-02645-z. PMID: 39054425; PMCID: PMC11270787.
7. Onyeaka H, Adeola J, Xu R, Pappy AL, Adeola S, Smucker M, Chang A, Fraga A, Ufondu W, Osman M, Hasoon J, Orhurhu VJ. Intravenous Lidocaine for the Management of Chronic Pain: A Narrative Review of Randomized Clinical Trials. Psychopharmacol Bull. 2024 Jul 8;54(3):73-96. PMID: 38993659; PMCID: PMC11235581.
8. Greenberg MS. Handbook of Neurosurgery. New York: Thieme Medical Publishers; 2006. 1000 p. https://archive.org/ details/handbookofneuros0006gree.
9. Xu R, Xie ME, Jackson CM. Trigeminal Neuralgia: Current Approaches and Emerging Interventions. J Pain Res. 2021 Nov 3;14:3437-3463. doi: 10.2147/JPR.S331036. PMID: 34764686; PMCID: PMC8572857.
10. Di Stani F, Ojango C, Dugoni D, Di Lorenzo L, Masala S, Delfini R, Bruti G, Simonetti G, Piovesan EJ, Ruggeri AG. Combination of pharmacotherapy and lidocaine analgesic block of the peripheral trigeminal branches for trigeminal neuralgia: a pilot study. Arq Neuropsiquiatr. 2015 Aug; 73(8):660-4. doi: 10.1590/0004-282X20150077. PMID: 26222356.
11. Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, Treede RD, Zakrzewska JM, Nurmikko T. Trigeminal neuralgia: New classification and diagnostic grading for practice and research. Neurology. 2016 Jul 12; 87(2):220-8. doi: 10.1212/ WNL.0000000000002840. Epub 2016 Jun 15. PMID: 27306631; PMCID: PMC4940067.
12. Dach F, Éckeli ÁL, Ferreira Kdos S, Speciali JG. Nerve block for the treatment of headaches and cranial neuralgias — a practical approach. Headache. 2015 Feb;55 Suppl 1:59-71. doi: 10.1111/head.12516. Epub 2015 Feb 3. PMID: 25644836.
13. Lee JY, Lee GH, Yi SH, Sim WS, Kim BW, Park HJ. Non- Surgical Treatments of Trigeminal Neuralgia from the Perspective of a Pain Physician: A Narrative Review. Biomedicines. 2023 Aug 21;11 (8):2315. doi: 10.3390/biomedicines11082315. PMID: 37626811; PMCID: PMC10452234.
14. Posokhov MF. Modern problems in neurosurgical treatment of pharmacoresistant facial pains. Ukrainskyi Visnyk Psykhonevrologii. [Ukrainian Bulletin of Psychoneurology]. 2016; 24(1):101-103. 15. Johnson CD, Yi SH., Kim B. et al. Age as a Factor in the Efficacy of Lidocaine Blockades for Trigeminal Neuralgia. Pain Medicine. 2018; 19(5):1007-1013.
16. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005 Aug; 14(7):798- 804. doi: 10.1111/j.1365-2702.2005.01121.x. PMID: 16000093.
17. Bahreini M, Jalili M, Moradi-Lakeh M. A comparison of three self-report pain scales in adults with acute pain. J Emerg Med. 2015 Jan; 48(1):10-18. doi: 10.1016/j.jemermed.2014.07.039. Epub 2014 Sep 27. PMID: 25271179.
18. Åström M, Thet Lwin ZM, Teni FS, Burström K, Berg J. Use of the visual analogue scale for health state valuation: a scoping review. Qual Life Res. 2023 Oct; 32(10):2719-2729. doi: 10.1007/s11136-023-03411-3. Epub 2023 Apr 7. PMID: 37029258; PMCID: PMC10474194.
19. Lund I, Lundeberg T, Sandberg L, Budh CN, Kowalski J, Svensson E. Lack of interchangeability between visual analogue and verbal rating pain scales: a cross sectional description of pain etiology groups. BMC Med Res Methodol. 2005 Oct 4;5:31. doi: 10.1186/1471-2288-5-31. PMID: 16202149; PMCID: PMC1274324.
20. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S240-52. doi: 10.1002/acr.20543. PMID: 22588748.
21. Lee CH, Jang HY, Won HS, Kim JS, Kim YD. Epidemiology of trigeminal neuralgia: an electronic population health data study in Korea. Korean J Pain. 2021 Jul 1;34(3):332-338. doi: 10.3344/kjp.2021.34.3.332. PMID: 34193639; PMCID: PMC8255158.
22. Al-Quliti KW. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options. Neurosciences (Riyadh). 2015 Apr;20(2):107-114. doi: 10.17712/nsj.2015.2.20140501. PMID: 25864062; PMCID: PMC4727618.
23. Ruscheweyh R, Lutz J, Mehrkens JH. Trigeminusneuralgie: Moderne Diagnostik und Therapie [Trigeminal neuralgia: Modern diagnostic workup and treatment]. Schmerz. 2020 Dec;34(6):486-494. German. doi: 10.1007/s00482-020-00496-4. Epub 2020 Sep 22. PMID: 32960312.
24. Zhao C, Shrestha N, Liu H, Shen Y, Meng L, Fan B, Luo F. The PATCH trial: efficacy and safety of 5 % lidocaine-medicated plaster for the treatment of patients with trigeminal neuralgia: a study protocol for a multicentric, double-blind, enriched enrolment randomised withdrawal, vehicle-controlled study. BMJ Open. 2021 Aug 2;11(8):e045493. doi: 10.1136/ bmjopen-2020-045493. PMID: 34341037; PMCID: PMC8330571.
25. Jafree DJ, Williams AC, Zakrzewska JM. Impact of pain and postoperative complications on patient-reported outcome measures 5 years after microvascular decompression or partial sensory rhizotomy for trigeminal neuralgia. Acta Neurochir (Wien). 2018 Jan;160(1):125-134. doi: 10.1007/s00701-017-3350- 6. Epub 2017 Oct 28. PMID: 29080911; PMCID: PMC5735194.
26. Balta S, Köknel Talu G. Clinical effectiveness of peripheral nerve blocks with lidocaine and corticosteroid in patients with trigeminal neuralgia. Agri. 2021 Oct;33(4):237-242. English. doi: 10.14744/agri.2021.26032. PMID: 34671954.
27. Lee CH, et al. Comparative study of effect of single and multiple nerve blocks on treatment of trigeminal neuralgia. J Korean Assoc Oral Maxillofac Surg. 2020; 46(1):29-36.
28. Ertilav E, Aydın ON. Evaluation of the effectiveness duration of peripheral blocks applied with high concentration local anesthetic and steroid in trigeminal neuralgia. Agri. 2022 Oct;34(4):264-271. English. doi: 10.14744/agri.2021.77854. PMID: 36300746.
29. Kim MJ, Son JY, Ju JS, Ahn DK. Early Blockade of EphA4 Pathway Reduces Trigeminal Neuropathic Pain. J Pain Res. 2020 May 22;13:1173-1183. doi: 10.2147/JPR.S249185. PMID: 32547180; PMCID: PMC7250313.
30. Han KR, Kim C, Chae YJ, Kim DW. Efficacy and safety of high concentration lidocaine for trigeminal nerve block in patients with trigeminal neuralgia. Int J Clin Pract. 2008 Feb;62(2):248-54. doi: 10.1111/j.1742-1241.2007.01568.x. Epub 2007 Nov 23. PMID: 18036166.
31. Fisher Yu. Lokalnoie lechenie boli [Local pain treatment]. M. : MEDpress-inform; 2006. 159 s. (In Russian).