| Objective: Trigeminal Neuralgia(TN)is a common cranial nerve disease,which is manifested as short facial electric shock pain,sudden appear and stop,lasting for a few seconds to a few minutes at a time,and the intermittent period is completely normal.Trigeminal.Mild stimulation such as washing face and brushing teeth can induce pain,which is usually confined to one side of the face,most commonly in the right V2 distribution area.They are more common in middle aged and old people,and slightly more in women than in men.Its etiology and pathogenesis are still unknown.The theory of microvascular compression and demyelinating alteration has been accepted by most scholars,which is related to the compression of the trigeminal nerve at the Root Entry Zone(REZ)by the microvascular.The most common vascular compression is the superior cerebellar artery.Other pathogeny has bone compression theory,tumour compression theory,allergic reaction theory,trace element deficiency theory and so on.There are many treatment methods for TN,and drug therapy is the first choice.Carbamazepine is often recommended as a first-line treatment for TN.Most patients can benefit from medication and the pain can be controlled,but it is difficult to cure TN.In addition,long-term medication is required,with relatively large side effects.As the disease progresses,some conditions such as decreased efficacy or intolerance to adverse drug reactions would occur.So surgical treatment such as Microvascular Decompression(MVD)had to be sought.Surgical treatment of TN mainly includes non-invasive MVD and invasive trigeminal nerve destruction such as radiofrequency thermocoagulation,balloon compression,trigeminal sensory ramus amputation.However,in some patients,skull Magnetic Resonance Imaging(MRI)showed no significant vascular compression in the REZ region,in which case MVD tended to be less effective.Other patients relapsed after MVD.The pain disappeared or significantly alleviated in most patients through drug and surgical treatment,but there are still somepatients with poor efficacy or recurrence.How to treat such patients is currently a clinical problem.A case has been reported that intravenous infusion of lidocaine and magnesium sulfate to successfully treat patients with intractable trigeminal neuralgia.Some scholars suggested that this method could be used to treat intractable trigeminal neuralgia.This article will study the method,possible mechanism and clinical effect of intravenous infusion of lidocaine combined with magnesium sulfate in the treatment of intractable trigeminal neuralgia,and explore the efficacy and feasibility of lidocaine combined with magnesium sulfate in the treatment of trigeminal neuralgia.Methods: Patients with intractable trigeminal neuralgia who had been treated with regular drugs and had no effect,MVD or postoperative recurrence in Northern Jiangsu Peoples Hospital were selected as the research objects.The patients with intractable trigeminal neuralgia were treated with 0.9% sodium chloride injection 100ml+2%lidocaine injection 5ml(0.1g)+ 25% magnesium sulfate injection 5ml(1.25g)intravenous drip for 1h once a week.According to the patient's pain relief,the number of treatment courses is determined.It is about 1-4 times in a row.During the intravenous drip,continuous electrocardingraphy should be conducted for at least 3-4hours,and attention should be paid to adverse reactions related to lidocaine and magnesium sulfate,such as shortness of breath and abnormal knee reflex.The efficacy was single-blindly assessed by nurses not involved in this study by using numerical rating scale(NRS)before the treatment and 1 week,2 weeks,4 weeks,2 months,4months after the treatment and last follow-up.All patients were followed up to at least 4months after treatment,and the pain score of lidocaine combined with magnesium sulfate intravenous infusion was obtained mainly through telephone follow-up and outpatient consultation.The NRS value and total effective rate at each evaluation point before and after treatment were calculated,and the NRS value was expressed by mean ±standard deviation.The NRS value and total effective rate at each evaluation point after treatment were compared with those before treatment to see whether there were statistical differences.Results: A total of 26 patients were included,including 14 cases of postoperative recurrence of MVD,1 cases of postoperative recurrence of trigeminal nerve destruction,and 11 cases of ineffective drug treatment.NRS scores was(8.88±0.62),(5.62±1.80),(2.84±1.42),(2.53±1.83),(2.73±1.86),(2.77±1.83)and(3.82±2.14)before and 1 week,2 weeks,4 weeks,2 months and 4 months after lidocaine and magnesium sulfate intravenous drip treatment respectively and last follow-up.NRS scores was gradually decreased,reached the lowest at 4 weeks after lidocaine and magnesium sulfate intravenous drip,and then was slightly fluctuating in the minimum level.There were significant differences in NRS scores between pre-and post-treatment(P<0.05).The total effective rate was 19.20%,92.30%,84.60%,84.60%,80.80%,61.50% at 1 week,2weeks,4 weeks,2 months and 4 months after the treatment respectively and last follow-up.There were significant differences in efficacy between different time points after the treatment(a11 P<0.05).During intravenous infusion of lidocaine combined with magnesium sulfate,26 patients had no adverse reactions related to lidocaine and magnesium sulfate,such as slow heart rate,decreased blood pressure,obvious shortness of breath and abnormal knee reflex.The mean follow-up time of the 26 patients was19.7(8~35)months.Conclusions: Intravenous administration of lidocaine combined with magnesium sulfate is easy to operate,safe to use,effective,pain-free,short course of combined use.At the same time,magnesium sulfate and lidocaine injection are easily available without restriction,and repeated use is still effective.It can greatly reduce the economic burden of patients.It is convenient to carry out in primary hospitals,providing more options for the treatment of TN. |
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