Ultrasound-guided trigeminal nerve block for treatment of shingles pain

Patient, male, 77Pain on the left side of the face and top of the chin was accompanied by a rash for more than 1 monthAdmission was diagnosed as a straphers after nerve pain, the proposed trigeminal nerve blockTake the reclining position, the mouth contains gauze roll, maintain the opening position, the head slightly tilted to the opposite side (Figure 1)Figure 1 The patient position and ultrasonic probe placementplace dihigh s /apron bottom, above the jaw bone, showing the wing protrusion outer side plate (lateral pterygoid plate, LPP), the probe sliding toward the head end to determine the top of the LPP, the front of which is the wing socket opening Using colored Doppler to assist in identifying the upper jaw artery in the wing armpit, it can also be used as a marker to use a plane puncture technique from the front to back to penetrate the 18G puncture needle through the outer wing muscle (lateral ptgoid muscle, LPM) into the wing armpit, under the upper jaw artery (Figure 2), injection of dexamethasone 1mg 1% Lidokain mixture 3 ml blocking the upper jaw nerve2 ultrasound guides the upper jaw nerve blockRed arrowshows the direction of the puncture needle Ant: front, Post: rear, LPP: wing extrusion outer side panel, LPM: wing muscle, MT: upper jaw knot, TM: armmusclepuncture needle retreats to the skin, changes the direction of the puncture needle, using the inner puncture technology from the front and back plane to penetrate the LPM into the lPP top rear edge, injection ground ermepine 1mg 1mgImage 3 Ultrasound guides the jaw nerve blockYellow arrow shows the direction of the puncture needle Ant: front, Post: after LPP: wing extremum side panel, LPM: wing muscle, MT: upper jaw knot, TM: temporalismuscle muscle5 minutes after observing analgesic effect, patient sin to reduce pain symptoms 70% to 80%, Lidoka in the diagnostic test positive, then use the same method in two points injection 0.375% Rochen 2.5mlThe immediate pain relief rate of patients with delay is 80%On the second day of follow-up after surgery, the patient's left side and facial pain was significantly reduced, the pain relief rate was about 90%, no other discomfort, continue oral medicationAfter 1 week of follow-up, the patient complained of pain slightly more seriousthanly than after surgery, but still significantly more significantly than before surgery, the mitigation rate was about 50% to 60%; was admitted to hospital again to consolidate treatmentdiscussed Trident nerve block is a common lysining treatment for trigeminal nerve pain The trident nerve is normally positioned with X-ray and CT guidance, but it is expensive, the needle cannot be adjusted in real time, and the operator is exposed to radiation Ultrasound examination in addition to real-time, visual guidance puncture, but also clearly display the surrounding nerves, blood vessels, bone, muscles and other key anatomical structures, more conducive to judging the anatomical positioning of nerves, design a safe puncture path; Ultrasound-guided through the wing edith triangular nerve blocking method at present, although there are sporadic reports at home and abroad, but are in the wing armpit single injection bureau drug blockthe upper jaw nerve the triboural upper jaw branch through the round hole out of the cranial armpit, through the winged palate (pterygopalatine fossa, PPF) after the division of several branches, including the upper palate nerve, the shin nerve, the upper tooth slot nerve, etc The jaw nerve enters the cranial armpit through the egg round hole into the lower armpit, and walks in the lPP posterior edge to separate several branches, including the ear drum nerve, tongue nerve, lower tooth groove nerve, etc From the above-mentioned anatomical structure, it can be seen that simply through injection of the bureau's drug to the wing socket will certainly exist in the jaw nerve block ingress, so for patients with severe jaw neuropathy, at the same time the jaw nerve block is necessary Nader and others were the first to report clinically the anatomical markers of the extra-wing muscle and the upper jaw artery, the wing arm pit trident nerve block, which successfully blocked the three branches of the trident nerve During operation, Nader et al use a back-to-front puncture path But the puncture path puncture needle is likely to enter the mumps, and the risk of facial nerve damage is higher And because the mouth is not open, PPF will be the jaw bone crown-like hidden cover, increase the ultrasonic display difficulty, needle tip can not accurately enter the wing armpit, thus affecting the blocking effect Kampitak et al in the autopsy found that, using Nader and other methods, puncture needle tip is located on the LPP adipose tissue, the bureau's drug is difficult to fully immerse in the PPF At the same time, Kampitak and other methods used this report to inject melanin on the body to find the upper jaw nerve, the wing palate nerve joint, the upper palate nerve size branch, the upper tooth groove nerve in the back of the branch are dyed It is proved that this method blocks the upper jaw nerve effect is accurate this report, the puncture needle from the back of the needle, to avoid wearing the mumps, so that the risk of facial nerve damage reduced In this method clearly shows that LPP is the key, in order to avoid LPP by the jaw bone coronahead cover, the patient needs to always maintain the opening position during the operation, which brings obvious discomfort to the patient In this operation, the patient contains gauze rolls, which not only allows the patient to maintain the opening position, but also can reduce the patient's discomfort It can be seen by anatomy, before the upper jaw nerve into the wing armpit, the jaw nerve has been divided, but it enters the lower armpit, walking in the LPP back edge, this is our use of a needle puncture two-point injection method, while blocking the upper jaw nerve and the jaw nerve anatomical basis Autopsies such as Kampitak proved that jaw nerve blocking through LPP was highly accurate and feasible The application of the technology reported in this paper is limited in clinical experience, and no large sample research report has been seen at home and abroad A large sample study should be conducted in the future to determine the superiority of this method Although the critical structures around the nerves, bone LPP and PPF can be shown well under ultrasound, the upper jaw nerves and the jaw nerves cannot be shown Therefore, the operation must be done by a doctor with some experience, and the needle tip must be displayed throughout the process to avoid serious consequences