UKRAINS'KYI VISNYK PSYKHONEVROLOHII

The Scientific and Practical Journal of Medicine
ISSN 2079-0325(p)
DOI 10.36927/2079-0325

COMBINED LIDOCAINE BLOCKADES WITH METHYLPREDNISOLONE IN THERAPY OF SEVERE TRIGEMINAL NEURALGIA: CLINICAL RESULTS

Type of Article

In the Section

Abstract

Objective. To estimate the efficacy of lidocaine blockades (LB) with methylprednisolone in patients with trigeminal neuralgia (TN) in both short- and long-term perspectives.

The study analyzed the treatment of 44 patients with TN using peripheral nerve blocks: 31 women (70.45%) and 13 men (29.54%); mean age ± sd — 62.50±13.46 years; disease duration — 8.97±9.6 years. The blocks were performed using a mixture of 4.0 ml of 2% lidocaine with 1.00 ml of 40 mg/ml of methylprednisolone acetate («Depo-Medrol») administered paraneurally. Pain intensity was assessed using the Visual Analog Scale (VAS) at various time points: from 30 minutes to three years after the blockades.

Pain intensity at admission ranged from 5.9 to 10 (8.66±1.06) cm on the VAS. Thirty minutes after the block, it decreased to 1.0—4.5 (2.75±0.67). Due to the return of pain, radical surgical interventions were performed in 36 patients. After 36 months, excellent and good results were achieved in 8 (18.18 %) patients.

Lidocaine blockades with methylprednisolone proved their high short-term efficacy with noticeable, however, decrease during first days with further restoration in terms from the first month to 3 years. The use of this approach is advisable as part of the comprehensive treatment of TN patients.

Pages

References

  1. de Siqueira SR, Vilela TT, Florindo AA. Prevalence of headache and orofacial pain in adults and elders in a Brazilian com-munity: an epidemiological study. Gerodontology. 2015;32(2):123-131. doi:https://doi.org/10.1111/ger.12063.
  2. Cruccu G. Trigeminal Neuralgia. Continuum (Minneap Minn). 2017;23(2, Selected Topics in Outpatient Neurology):396-420. doi:https://doi.org/10.1212/CON.0000000000000451.
  3. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Hea-dache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211. doi:https://doi.org/10.1177/0333102417738202.
  4. 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;34(3):332-338. doi:https://doi.org/10.3344/kjp.2021.34.3.332.
  5. Allam AK, Sharma H, Larkin MB, Viswanathan A. Trigeminal Neuralgia: Diagnosis and Treatment. Neurol Clin. 2023;41(1):107-121. doi:https://doi.org/10.1016/j.ncl.2022.09.001.
  6. Gambeta E, Chichorro JG, Zamponi GW. Trigeminal neuralgia: An overview from pathophysiology to pharmaco-logical treatments. Mol Pain. 2020;16:1744806920901890. doi:https://doi.org/10.1177/1744806920901890.
  7. Khadilkar SV, Patil VA. Medical Management of Trigemi-nal Neuralgia. Neurol India. 2021;69(Supplement):S199-S205. doi:https://doi.org/10.4103/0028-3886.315996.
  8. Posokhov M. F. Modern problems in neurosurgical treat-ment of pharmacoresistant facial pains Український вісник психоневрології [Ukrainian Bulletin of Psychoneurology]. 2016;24;1(86):101-103 (In English).
  9. 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;160(1):125-134. doi:https://doi.org/10.1007/s00701-017-3350-6.
  10. Jacques N, Karoutsos S, Marais L, Nathan-Denizot N. Quality of life after trigeminal nerve block in refractory tri-geminal neuralgia: A retrospective cohort study and litera-ture review. J Int Med Res. 2022;50(10):3000605221132027. doi:https://doi.org/10.1177/03000605221132027.
  11. Chiu KM, Lu CW, Lee MY, Wang MJ, Lin TY, Wang SJ. Neu-roprotective and anti-inflammatory effects of lidocaine in kainic acid-injected rats. Neuroreport. 2016;27(7):501-7. doi:https://doi.org/10.1097/WNR.0000000000000570.
  12. Sekimoto K, Tobe M, Saito S. Local anesthetic toxi city: acute and chronic management. Acute Med Surg. 2017;4(2):152-160. doi:https://doi.org/10.1002/ams2.265.
  13. Tajali Y, Ward M, Abraham M, Hillen M, Mahmoud O, Herschman Y, Mammis A, Paskhover B. Minimally invasive tri-geminal ablation in patients with refractory trigeminal neuralgia who are ineligible for intracranial intervention. J Clin Neurosci. 2019;70:42-46. doi:10.1016/j.jocn.2019.09.002.
  14. R Core Team (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL: https://www.R-project.org/.
  15. Eker HE, Cok OY, Aribogan A, Arslan G. Management of neuropathic pain with methylprednisolone at the site of nerve injury. Pain Med. 2012;13(3):443-51. doi:https://doi.org/10.1111/j.1526-4637.2011.01323.x.
  16. Balta S, Köknel Talu G. Clinical effectiveness of periphe-ral nerve blocks with lidocaine and corticosteroid in patients with trigeminal neuralgia. Agri. 2021;33(4):237-242. English. doi:https://doi.org/10.14744/agri.2021.26032.
  17. Di Stani F, Ojango C, Dugoni D, Di Lorenzo L, Masa-la 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;73(8):660-4. doi:https://doi.org/10.1590/0004-282X20150077.
  18. Ertilav E, Aydın ON. Evaluation of the effectiveness duration of peripheral blocks applied with high concentra-tion local anesthetic and steroid in trigeminal neuralgia. Agri. 2022;34(4):264-271. English. doi:https://doi.org/10.14744/agri.2021.77854.
  19. Posokhov M.F. Effectiveness of lidocaine blockades in patients with severe forms of trigeminal neuralgia // Ukrainian Journal of Psychoneurology. 2024. Vol. 32, issue 3(120). С. 4-13. Posokhov M. F. Effectiveness of lidocaine blockades in patients with severe forms of trigeminal neuralgia. Ukrainskyi visnyk psykhonevrolohii [Ukrainian Bulletin of Psychoneurology]. 2024;32, 3(120):4-13. doi:https://doi.org/10.36927/2079-0325-V32-is3-2024-1. (In Ukrainian).
  20. Faiz KW. VAS–visuell analog skala [VAS–visual analog scale]. Tidsskr Nor Laegeforen. 2014;134(3):323. Norwegian. doi:https://doi.org/10.4045/tidsskr.13.1145.
  21. Bahreini M, Jalili M, Moradi-Lakeh M. A comparison of three self-report pain scales in adults with acute pain. J Emerg Med. 2015;48(1):10-8. doi:https://doi.org/10.1016/j.jemermed.2014.07.039.
  22. Sung YT, Wu JS. The Visual Analogue Scale for Rating, Ranking and Paired-Comparison (VAS-RRP): A new technique for psychological measurement. Behav Res Methods. 2018;50(4):1694-1715. doi:https://doi.org/10.3758/s13428-018-1041-8.