Trigeminal nevraljili hastalarda lidokain ve kortikosteroid kombinasyonuyla yapılan periferik sinir bloklarının klinik etkinliği

Amaç: Kolay uygulanabilir periferik sinir bloklarının klinik etkinliği, gelişmiş ekipman gerektiren açık ve kapalı cerrahi prose- dürler haricinde ilgi konusudur. Trigeminal nevraljide periferik sinir dallarına triamsinolon ve lidokain enjeksiyon uygulaması- nın klinik etkinliğini ağrı şiddeti, ağrı sıklığı ve kullanılan ilaç dozları açısından değerlendirmeyi amaçladık. Gereç ve Yöntem: Bu retrospektif kohort çalışmada 2011–2018 yılları arasında lidokain ve triamsinolon ile periferik trigeminal sinir bloğu yapılan trigeminal nevraljili 72 hastanın sonuçları değerlendirildi. Ağrı şiddeti, ağrı sıklığı, karbamazepin ile prega- balin eşdeğer dozlarının işlem öncesine göre işlem sonrası 1, 3 ve 6. aylardaki sonuçları değerlendirildi. Ayrıca işlem başarısı ile bağımsız değişkenler arasında bir korelasyon olup olmadığını değerlendirildi. Bulgular: İşlem öncesi ağrı şiddeti ve ağrı sıklığı değerleri ile işlem sonrası 1, 3 ve 6. aylar arasında istatistiksel olarak anlamlı bir fark vardı (p=0.000). İşlem öncesi karbamazepin eşdeğer dozları ile işlem sonrası 3 ve 6. aydaki değerler arasında istatistiksel olarak anlamlı bir fark vardı (sırasıyla p=0.002, 0.005). Retrospektif analizde, bir hastada işlem alanına bağlı olarak yaklaşık bir hafta süren ağrısız parestezi ve iki hastada işlem bölgesinde ekimoz gelişmiş olduğu saptandı. Sonuç: Trigeminal sinirin periferik dallarına lidokain ve kortikosteroid enjeksiyonu ile kısa ve orta vadede klinik rahatlama sağlanabilir. Periferik sinir blokları, nadir görülen komplikasyonları kısa-orta vadede ağrı tedavisi için tercih edilebilir.

Clinical effectiveness of peripheral nerve blocks with lidocaine and corticosteroid in patients with trigeminal neuralgia

Objectives: Clinical efficacy of easily applicable peripheral nerve blocks has been in interest except open and closed surgical procedures requiring advanced equipment. We aimed to evaluate the clinical efficacy of triamcinolone and lidocaine injec - tion for peripheral nerve branches in trigeminal neuralgia (TN) in terms of pain severity, pain frequency, and drug doses used. Methods: This study was a retrospective cohort study. A total of 72 patients with TN, who underwent peripheric trigeminal nerve injection with lidocaine and triamcinolone between 2011 and 2018, were included in the study. Pain severity, pain fre- quency, changes in carbamazepine (CBZ) equivalent doses, and pregabalin equivalent doses were evaluated. We also evalu- ated whether there was a correlation between the success of the procedure and independent variables. Results: There was a statistically significant difference in pain intensity and frequency between baseline and post-procedure at 1, 3, and 6 months (p=0.000). There was a statistically significant difference between CBZ equivalent doses at baseline, and 3 and 6 months after the procedure (p=0.002 and 0.005, respectively). Two complications were evaluated, one patient had prolonged painless paresthesia related to the procedure area lasting about 1 week and two patients had ecchymosis at the procedure area. Conclusion: The injection of lidocaine and corticosteroid combination for peripheral branches of the trigeminal nerve may result in short and mid-term clinical relief. Peripheral nerve blocks may be preferred for short-medium-term pain management with rare complications and simple device requirements also need little experience and skills.

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