Journal of Korean Neurosurgical Society

  • 제63권6호
  • /
  • Pages.814-820
  • /
  • 2020
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

Clinical Outcome of Percutaneous Trigeminal Nerve Block in Elderly Patients in Outpatient Clinics

  • Seo, Hyek Jun (Department of Neurosurgery, School of Medicine, Kyung Hee University) ;
  • Park, Chang Kyu (Department of Neurosurgery, School of Medicine, Kyung Hee University) ;
  • Choi, Man Kyu (Department of Neurosurgery, School of Medicine, Kyung Hee University) ;
  • Ryu, Jiwook (Department of Neurosurgery, School of Medicine, Kyung Hee University) ;
  • Park, Bong Jin (Department of Neurosurgery, School of Medicine, Kyung Hee University)
  • 투고 : 2020.05.12
  • 심사 : 2020.08.17
  • 발행 : 2020.11.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : Trigeminal neuralgia (TN) is a severe neuropathic condition that affects several elderly patients. It is characterized by uncontrolled pain that significantly impacts the quality of life of patients. Therefore, the condition should be treated as an emergency. In the majority of patients, pain can be controlled with medication; however, other treatment modalities are being explored in those who become refractory to drug treatment. The use of the trigeminal nerve block with a local anesthetic serves as an excellent adjunct to drug treatment. This technique rapidly relieves the patient of pain while medications are being titrated to effective levels. We report the efficacy and safety of percutaneous trigeminal nerve block in elderly patients with TN at our outpatient clinic. Methods : Twenty-one patients older than 65 years with TN received percutaneous nerve block at our outpatient clinic. We used bupivacaine (1 mL/injection site) to block the supraorbital, infraorbital, superior alveolar, mental, and inferior alveolar nerves according to pain sites of patients. Results : All patients reported relief from pain, which decreased by approximately 78% after 2 weeks of nerve block. The effect lasted for more than 4 weeks in 12 patients and for 6 weeks in two patients. There were no complications. Conclusion : Percutaneous nerve block procedure performed at our outpatient clinic provided immediate relief from pain to elderly patients with TN. The procedure is simple, has no serious side effects, and is easy to apply.

키워드

참고문헌

  1. Amirnovin R, Neimat JS, Roberts JA, Eskandar EN : Multimodality treatment of trigeminal neuralgia. Stereotact Funct Neurosurg 83 : 197-201, 2005 https://doi.org/10.1159/000091083
  2. Arici T, Kurcaloglu M, Kilic E, Erhan E : Radiofrequency thermocoagulation combined with pulsed radiofrequency for gasserian ganglion blockage. Agri 30 : 179-182, 2018
  3. Ashkan K, Marsh H : Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy. Neurosurgery 55 : 840-848; discussion 848-850, 2004 https://doi.org/10.1227/01.NEU.0000137660.06337.C5
  4. Bahgat D, Ray DK, Raslan AM, McCartney S, Burchiel KJ : Trigeminal neuralgia in young adults. J Neurosurg 114 : 1306-1311, 2011 https://doi.org/10.3171/2010.10.JNS10781
  5. Bertilsson L : Clinical pharmacokinetics of carbamazepine. Clin Pharmacokinet 3 : 128-143, 1978 https://doi.org/10.2165/00003088-197803020-00003
  6. Dach F, Eckeli AL, Ferreira Kdos S, Speciali JG : Nerve block for the treatment of headaches and cranial neuralgias - a practical approach. Headache 55 Suppl 1 : 59-71, 2015
  7. Emril DR, Ho KY : Treatment of trigeminal neuralgia: role of radiofrequency ablation. J Pain Res 3 : 249-254, 2010 https://doi.org/10.2147/JPR.S14455
  8. Fernandez C, Reader A, Beck M, Nusstein J : A prospective, randomized, double-blind comparison of bupivacaine and lidocaine for inferior alveolar nerve blocks. J Endod 31 : 499-503, 2005 https://doi.org/10.1097/01.don.0000167395.61075.38
  9. Fraioli MF, Cristino B, Moschettoni L, Cacciotti G, Fraioli C : Validity of percutaneous controlled radiofrequency thermocoagulation in the treatment of isolated third division trigeminal neuralgia. Surg Neurol 71 : 180-183, 2009 https://doi.org/10.1016/j.surneu.2007.09.024
  10. Hascalovici JR, Robbins MS : Peripheral nerve blocks for the treatment of headache in older adults: a retrospective study. Headache 57 : 80-86, 2017 https://doi.org/10.1111/head.12992
  11. Hong T, Ding Y, Yao P : Long-term efficacy and complications of radiofrequency thermocoagulation at different temperatures for the treatment of trigeminal neuralgia. Biochem Res Int 2020 : 3854284, 2020
  12. Ilfeld BM : Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg 113 : 904-925, 2011 https://doi.org/10.1213/ANE.0b013e3182285e01
  13. Ilfeld BM, Viscusi ER, Hadzic A, Minkowitz HS, Morren MD, Lookabaugh J, et al. : Safety and side effect profile of liposome bupivacaine (exparel) in peripheral nerve blocks. Reg Anesth Pain Med 40 : 572-582, 2015 https://doi.org/10.1097/AAP.0000000000000283
  14. Kanpolat Y, Savas A, Bekar A, Berk C : Percutaneous controlled radiofrequency trigeminal rhizotomy for the treatment of idiopathic trigeminal neuralgia: 25-year experience with 1,600 patients. Neurosurgery 48 : 524-532; discussion 532-534, 2001 https://doi.org/10.1097/00006123-200103000-00013
  15. Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G : Trigeminal neuralgia - diagnosis and treatment. Cephalalgia 37 : 648-657, 2017 https://doi.org/10.1177/0333102416687280
  16. Maarbjerg S, Heinskou TB, Wolfram F, Rochat P, Brennum J, Bendtsen L : Diagnostics and treatment of trigeminal neuralgia. Ugeskr Laeger 178 : V02160146, 2016
  17. Marchetti M, Pinzi V, De Martin E, Ghielmetti F, Fariselli L : Radiosurgery for trigeminal neuralgia: the state of art. Neurol Sci 40(Suppl 1) : 153-157, 2019 https://doi.org/10.1007/s10072-019-03814-6
  18. Marshall K, Chan MD, McCoy TP, Aubuchon AC, Bourland JD, McMullen KP, et al. : Predictive variables for the successful treatment of trigeminal neuralgia with gamma knife radiosurgery. Neurosurgery 70 : 566-572; discussion 572-573, 2012 https://doi.org/10.1227/NEU.0b013e3182320d36
  19. Oomens MA, Forouzanfar T : Pharmaceutical management of trigeminal neuralgia in the elderly. Drugs Aging 32 : 717-726, 2015 https://doi.org/10.1007/s40266-015-0293-6
  20. Perloff MD, Chung JS : Urgent care peripheral nerve blocks for refractory trigeminal neuralgia. Am J Emerg Med 36 : 2058-2060, 2018 https://doi.org/10.1016/j.ajem.2018.08.019
  21. Sarsam Z, Garcia-Finana M, Nurmikko TJ, Varma TR, Eldridge P : The long-term outcome of microvascular decompression for trigeminal neuralgia. Br J Neurosurg 24 : 18-25, 2010 https://doi.org/10.3109/02688690903370289
  22. Stienen MN, Cadosch D, Seule MA, Fournier JY, Hildebrandt G, Gautschi OP : Trigeminal neuralgia - pathophysiology, clinical aspects and treatment. Praxis (Bern 1994) 99 : 29-43, 2010 https://doi.org/10.1024/1661-8157/a000005
  23. Wilkinson HA : Trigeminal nerve peripheral branch phenol/glycerol injections for tic douloureux. J Neurosurg 90 : 828-832, 1999 https://doi.org/10.3171/jns.1999.90.5.0828
  24. Xia L, Zhong J, Zhu J, Wang YN, Dou NN, Liu MX, et al. : Effectiveness and safety of microvascular decompression surgery for treatment of trigeminal neuralgia: a systematic review. J Craniofac Surg 25 : 1413-1417, 2014 https://doi.org/10.1097/SCS.0000000000000984
  25. Yadav YR, Nishtha Y, Sonjjay P, Vijay P, Shailendra R, Yatin K : Trigeminal neuralgia. Asian J Neurosurg 12 : 585-597, 2017 https://doi.org/10.4103/ajns.AJNS_67_14