Evaluation of sphenopalatine ganglion blockade via intra oral route for the management of atypical trigeminal neuralgia.

Ilker Coven,Ezher H Dayısoylu

doi:10.1186/s40064-016-2612-8

Ilker Coven, Ezher H Dayısoylu

Open Access

https://doi.org/10.1186/s40064-016-2612-8

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Abstract

BackgroundThe sphenopalatine ganglion (SPG) may be involved in persistent idiopathic facial pain and unilateral headaches. The role of SPG blockade via intra oral route in the management of trigeminal neuralgia (TN) is worthy of study.MethodsIn this retrospective study, patient records included patients with atypical TN (type 2) that persisted in spite of conservative treatment for at least 2 years, and an average pain intensity from the craniofacial region visual analogue scale (VAS) before examination. In group I the patients received carmapazepin 800 mg a day for at least 2 years. In group II 3 ml of local anesthetic agent consisting 2 ml bupivacaine and 1 ml prilocain in addition to 1 ml fentanyl, 0.5 ml betametasone disodium phosphate and 0.5 ml opaque was injected by the intraoral route. In this group, injection procedures were performed under local anesthesia with fluoroscopic guidance. The Kruskal–Wallis and Mann–Whitney U tests with Bonferroni correction were used for intergroup analysis. Age and sex differences were evaluated with one-way ANOVA and Fisher’s exact tests, respectively.ResultsSignificant differences were found between pre-op and 3rd day VAS values and also pre-op and 1st month VAS values. No significant differences were found between pre-op and 6th month VAS values.ConclusionThe SPG blockade improves the quality of life of patients and a minimally-invasive procedure to management of TN, when compared to other methods.

Highlights

The sphenopalatine ganglion (SPG) may be involved in persistent idiopathic facial pain and unilateral headaches
Surgical and minimal invasive management strategies have been developed that suggested by Academy of Neurology (AAN)–European Federation of Neurological Societies (EFNS) as an option for the patients refractory to drugs or have adverse reactions (Di Stefano et al 2014)
In this study it was aimed to investigate the effectiveness of SPG blockade via intraoral route with bupivacaine and fentanyl combination for the management of trigeminal neuralgia (TN) type 2

Summary

Methods

Patient records were included that patients with atypical trigeminal neuralgia (TN type 2) persisted in spite of conservative treatment (oral carbamazepine 800 mg a day) for at least 2 years, and an average pain intensity from the craniofacial region of >30 mm on a 0–100 mm visual analogue scale (VAS) before examination (Cruccu et al 2008). Patients with a minimum follow up time for 2 years were included whereas patients with other types of trigeminal neuralgia, cluster headache, operated for trigeminal neuralgia or psycological disorders were excluded (Cruccu et al 2008). No significant differences were found in pre-treatment evaluation between the groups, significant differences were found between the groups I and II at 3rd day and 1st month VAS values (p < 0.01). On the other hand no significant differences were found between the groups I and II at 6th month VAS values (p > 0.05).

Background

Discussion