Failure of waterless ethanol causes 1 case of trigeminal nerve pain treatment failure

Waterless ethanol is widely used as a neuro-destructive drug in the treatment of trigeminal nerve pain, which is mainly used for the destruction of the branches around the trigeminal nerveBecause of the stable chemical properties of waterless ethanol, long-term use has become aclinicalexperienceconsensus, and according to the State Administration of Quality Inspection GB/T678-2002, waterless ethanol as a chemical reagent does not indicate the shelf life, so the failure of waterless ethanol is often ignoredThis paper reports a case of failure of the failure of waterless ethanol-caused trigeminal nerve pain treatment, explores the causes of failure, summarizes lessons learned, and provides guidance for our relevantclinical1General informationpatients, female, 71 years old, due to "right facial pain for more than ten years, aggravated by 1 week" admission, cleardiagnosisas "right primary trigeminal trigeminal nerve pain 2nd", the trigeminal semi-month radio frequency heat coagulation pain significantly alleviated, strength reduction, decreased number of seizures, area reductionin order to deal with the residual symptoms, by the deputy director of the department in the neurostimulation device to guide the lower nerve and upper jaw nerve waterless ethanol de-destruction, the operation of the nerve positioning is accurate, the lower nerve puncture point injection 2% Lidocaine 0.5 ml, the upper jaw nerve puncture point injection 2% Lidocaine after 1 ml of pain significantly reduced, the numbness significantly increased, no adverse reactions to observe the nerve puncture Water ethanol (lot number 20141128, National Pharmaceutical Group Chemical Reagent Co., Ltd.) 0.5 ml, upper jaw nerve puncture point injection of waterless ethanol 1 ml (the above-mentioned waterless ethanol use in accordance with the clinical drug "three check seven pairs" principle, confirm the use of pre-preparation no deterioration, turbidity, internal and external two layers of seal no loose, shedding), surgical needle, fixed eye, patient return wardthe 2nd morning room, the patient complained of no improvement in pain, check body: no significant swelling of the face, pain (-)On the same day by the department another senior senior doctor operation, the previous day deputy director of the physician as an assistant, once again line the nerve and upper jaw nerve waterless ethanol de-destruction, operation with the previous time On the 3rd day the patient still complained of pain and did not improve, and the same day as the previous day The 4th day by the section director (chief physician) operation, line upper jaw neuroethanol destruction, operation in accordance with the norms, the specific process with the previous two, because of the failure to claim the new waterless ethanol, this treatment using 75% ethanol injection (name German brand 75% ethanol disinfection liquid, batch number 170802, Texas Famous de disinfection Technology Co., Ltd.) dosage 1ml the 5th day of patient pain significantly alleviated, visual simulation score (visual analoge scale, VAS) score 2 to 4 points, the number of seizures significantly reduced, check body: lower part of the urinary, nose and wing swelling (plus) On the 7th day of the 7th line of 75% ethanol hypothumalysis nerve damage surgery, the pain further improved, the residual symptoms are slight, check the body: the lower part of the lower part of the urinal, the outside of the nose wing swelling (s) patient satisfied with discharge, 2 weeks after the follow-up patient recovered well, local swelling disappeared, pain disappeared 2 Discussion ethanol neuro-destructive effect is cholesterol , phosphorus, cerebroside and mucoproteins extracted by dehydration, acting on the nerve fiber section and myelin phospholipids, resulting in demyelin The minimum concentration of ethanol with satisfactory therapeutic effect withnosic local paralysis or paralysis is 33%, ethanol from 48% to 100% can produce incomplete temporary, active or persistent motion paralysis; Ethanol chemical properties are very stable, in the light- and ventilation can be long-term preservation, in the absence of catalysts, very difficult to react with other substances, but waterless ethanol has a strong affinity for water, can quickly absorb water from the air aqueous ethanol is not 100% pure ethanol, in the beginning of preparation mixed with 0.3% methanol, moisture, isopropanol and other impurities, these impurities may also be an important factor leading to the deterioration of aqueous ethanol This case eventually used 75% ethanol to achieve the desired therapeutic effect, but also can confirm the previous use of "waterless ethanol" due to long-term repeated suction use, exposure to air and deterioration, the effective concentration has been far below expectations The case used aqueous ethanol original 500 ml, to the patient's use has been left less than 200 ml, nearly 1 year has been used as a department nerve damage medicine, the use of strictly in accordance with the clinical drug "three check seven pairs" principle, confirm the use of the pre-drug no deterioration, turbidity, internal and external two layers of seal scout, the use of strictly in accordance with the operating norms of the use of sterile syringes after the rapid closure of the bottle, the operation process However, by the department staff review, nearly 3 weeks or so of waterless ethanol on the nerve, lower nerve and other nerve damage treatment, but also have poor results, because of the disease cover-up and other factors have not been able to expose the corresponding problems, caused sufficient attention , it is speculated that the deterioration failure of aqueous ethanol was the main cause of the failure of the first two treatments in this case Ethanol can cause significant peripheral tissue damage, including coagulation necrosis characterized by extensive eosinophilic staining, complete axon deficiency, myelin degeneration and the appearance of long-flying knots and cast-cell nodules, which are clinically characterized by significant swelling at the injection site The first two treatments in this case did not appear around the injection site swelling, unlike the previous non-water-free ethanol nerve damage after the clinical manifestations of local significant swelling, is our main finding of the problem of the main hint This can also be used as a qualified and effective use of aqueous ethanol preparation sororcing for neurodeclaims therapy In summary, strictly in accordance with the norms of the preservation of drugs, preparations, strengthen the knowledge of drug chemistry, enhance risk awareness prevention, promote the safety and effectiveness of medical behavior