Effectiveness of hydrocortisone-procain blockages in patients with severe forms of trigeminal neuralgia

Abstract

Purpose of work: to study the effectiveness of hydrocortisone-procaine blockades (HPB) in patients with severe forms of trigeminal neuralgia in the near and distant terms. The treatment of 46 patients with trigeminal neuralgia (TN) was analysed. Of them 16 were men (34.78 %), 30 women (65.22 %). They ranged in age from 20 to 88 (mean 62.20 ± 13.03) years. A mixture of 4.0 ml of 2 % procaine solution and 50 mg of hydrocortisone suspension (hydrocortisone-procaine mixture) was used to perform GPB, which was injected peri- and paraneurally into the “affected” branches of the trigeminal nerve according to the generally accepted technique. The total number of blockades varied from 1 to 5, with an average of 2.17 ± 1.27. The efficacy was evaluated at different times after the blockades using visual analogue scale and rating analogue scale at different times: before treatment, after 30 min, after 6 hours, 24 hours, after 3 days, 1 month, 3 months, 6 months, 1 year, 2 years and 3 years after the blockades. GPB of the peripheral branches of trigeminal nerve in 46 patients with severe pharmacoresistant forms of TN are effective in 100.00 % of patients in the first 3—6 hours after their performance. Further the analgesic effect of GPB decreases, especially in the nearest month, in connection with which there is a necessity to apply more radical techniques of neurosurgical treatment. Excellent long-term results (in 2—3 years) after blockades application on the background of adequately selected pathogenetic therapy of both the main and accompanying diseases of the nervous system and internal organs were achieved in 8 (17.39 %) out of 46 patients. The analysed data indicated that GPB of peripheral branches of trigeminal nerve can be used in the treatment of pain syndrome in TN. Key words: trigeminal neuralgia, drug denervation, hydrocortisoneprocaine blockades