Lidoca in combination with magnesium sulfate intravenous drips to treat stubborn trigeminal nerve pain.

Trigeminal nerve pain (trigeminal neuralgia, TN) is a common clinical cranial nerve disease, the cause is not yet clear, many treatment methods, the efficacy is not the same, including drug incurability and postoperative recurrence of cases belong to stubborn trigeminal nerve pain, is the current difficulty of treatment!---- At present, it is believed that the etiology of TN includes primary and secondary, and the recognized primary etiology is dominated by microvascular compression (micro-vein, MVC)TN has a variety of treatment methods, preferred drug treatment, including systemic drug use and partial drug use, systemic drug treatment initial efficacy is significant, but it is difficult to cure TN, and need long-term medication, side effects are larger; Therefore, surgical treatment is recommended when the drug is not effective or when the patient has difficulty to tolerate the side effects of the drugTN's surgical treatment mainly includes microvascular devascular decompression (microvascular dejunets, MVD) with no damage to the trigeminal nerve, as well as damaged transdermal trigeminal nerve half-moon nerve coinal rfonation, transdermal puncture trigeminal nerve semi-moon cyatic saccompression, trigeminal nerve damage surgery such as trigeminal nerve hyptochio, and gamma knife and therapyHowever, these treatments are often ineffective for patients with persistent trigeminal nerve painThe study found that by supplementing the missing magnesium ions in TN patients, pain relief can be effective, so for patients with persistent trigeminal nerve pain, can try intravenous drips of Lidocain and magnesium sulfateSince February 2015, our hospital has achieved remarkable results in patients with persistent trigeminal nerve pain with Lidocain combined with magnesium sulfate intravenous drip therapyThis study will focus on Lidocain combined with magnesium sulfate intravenous drip treatment of stubborn trigeminal nerve pain, possible mechanism of action, clinical efficacy and so on1Object and Method 1.1 All cases in the study were from stubborn trigeminal nerve pain treated at sub-North People's Hospital from February 2015 to May 2017, for a total of 15 cases, of which 5 were for men and 10 in womenThe average age is 59.5 (43-91) yearsAverage course of disease 7.1 (0.25-20) years11 cases were single-branch edited pain, the first 1 case, the second 9 cases, the third 1 case, 4 cases were two distribution pain, the first and the second branch 2 cases, the first and the third 1 case, the second and the third 1 case5 cases were ineffective drug treatment, 9 were mvD recurrence after surgery, and 1 was recurrence after trigeminal nerve damageSelection criteria: (1) according to the diagnostic criteria of TN, has been diagnosed as TN, after regular drug treatment, pain is not alleviated or poor lysathing; Exclusion criteria: (1) patients who do not meet the TN diagnosis, such as pain sites and other patients with cerebral nerve pain and pain disorders similar to TN; (2) electrocardiograms indicative of significant arrhythmia, (3) patients with mental illness, such as depression, neurological dysfunction, rickets, and (4) those with bridge microcephaly, CPA tumors1.2 method 15 patients were given Lidocain combined magnesium sulfate intravenous drip therapy, the specific operation is 2% Lidocain injection 5 ml (0.1g) and 25% magnesium sulfate injection 5 ml (1.25g) added to 100 ml 0.9% sodium chloride injection, intravenous drip, 1h drop, once a week, according to the patient to relieve pain, treatment 1 to 3 timesDuring intravenous drip, continuous electrocardiogram monitoring, attention to shortness of breath, knee reflex abnormalities and other Lidoca inandiand and magnesium sulfate-related adverse reactions Designated caregivers unrelated to this study, using the pain numerical evaluation scale (NRS) for patients before and after treatment pain single-blind assessment, NRS value is 0 to 10 points, 0 is divided into painless, 1 to 3 divided into mild pain, 4 to 6 divided into moderate pain, 7 to 9 divided into severe pain (cannot sleep or sleep pain wake up), 10 points into unbearable severe pain The NRS was evaluated for 1 week, 2 weeks, 4 weeks, February, April and last follow-up nRS before and after treatment, with an average follow-up time of 19.7 (8 to 35 months) 1.3 The effectiveness assessment criteria pain disappear is cure, pain reduction of more than 75% is effective, pain reduction of 50% to 75% is effective, pain reduction of less than 50% is ineffective The percentage of total samples reduced by 50% or more of the total amount of pain was always effective 1.4 Statistical analysis using SPSS17.0 statistical software for statistical analysis The NRS valuewas in the mean of standard deviation (x-s), and the anova analysis was used to compare the NRS values of each group with the pre-treatment assessment point after treatment, and the effective use of the x2 test for the groups and pre-treatment assessment points after the comparison of treatment P 0.05 is statistically significant 2 Results 2.1 intravenous drip number patients received Lidocain combined with magnesium sulfate after the first drip 1 week, to conduct AnRS score, if the pain is not significantly relieved, drip second time, and so on Of the 15 patients in this group, 1 time 6 cases of drip and 2 9 cases 2.2 Intravenous drip pain change before and after treatment Before the NRS score is (8.9 x 0.7), 1 week after treatment (6.1 x 1.9), 2 weeks (2.6 x 1.3), 4 weeks (2.1 x 1.7), February (2.2 x 1.6), April (2.1 x 1.7), last follow-up (2.1 x 1.8) minutes Compared to pre-treatment, the Post-treatment NRS score was significantly lower, with a statistically significant difference (P 0.05) The NRS score was minimized at 4 weeks after treatment, after which the NRS score fluctuated slightly at a lower level After the pain relief, 15 patients' pain relief to the extent that they could tolerate it, did not take any medication to aid the analgesia, and was able to tolerate mild pain in a normal life 2.3 Analysis of the efficacy of intravenous drip treatment Lidoca in combination with magnesium sulfate intravenous drip treatment after 1 week, 2 weeks, 4 weeks, February, April, the last follow-up of the total efficiency of 7%, 100%, 100%, 100%, 93%, respectively, compared with the pre-treatment, except 1 week after treatment, the difference shady (P 0.05) See Table 1 2.4 Adverse reactions 15 patients in the course of treatment, no heart rate slowing down, blood pressure drop, no obvious shortness of breath, knee reflex abnormalities and other Lidoca and magnesium sulfate-related adverse reactions 2.5 Typical cases first: patient, male, 71 years old, right trigeminal nerve third distribution area pain for 4 years, take carmapine 0.2gbid, standard treatment is ineffective, MRI suggests the right trigeminal nerve sensory root into the brain stem (Root Enter Zone, REZ) has vascular compression (Figure 1) Before treatment, NRS was 7.8 points, Lidocain combined magnesium sulfate drop 1 time, after 2 weeks of treatment pain significantly relieved until disappeared, has been followed up for 28 months, no recurrence of pain Second case: patient, male, 65 years old, right trigeminal nerve second distribution area for 4 years, take karmapine 0.2gbid, standardized treatment is ineffective, MRI suggests that the right trigeminal nerve REZ region has vascular compression (Figure 2), microvascular decompression, 22 days after surgery pain recurrence Before treatment, NRS was 8.6 points, Lidocain combined magnesium sulfate drop 2 times, after treatment 2 weeks pain significantly relieved until disappeared, has been followed up for 35 months, no recurrence of pain