| Objective: Pain can cause negative emotion of the patients including different degrees of fear, anxiety and depression, etc. These changes not only affect the outcome of pain, but also amplify the pain response and change the patients' behavior and motion, thus affecting their daily life and work, and even causing painful disability or affecting their life. Therefore, chronic pain has become a kind of disease that seriously endangers human health and has received extensive attention from the international medical field.Among them, the trigeminal neuralgia(TN) is a common chronic refractory neuralgia, known as the worst pain for its grievous degree[1]. There are a lot of methods for treating TN at present, mainly divided into medicines and surgical treatment. When medicines do not work or may cause serious side effects, surgery may be the only solution for some patients. Radiofrequency thermocoagulation(RFT) of trigeminal gasserian ganglion is a commonly used minimally invasive surgical treatment for TN. Most of the TN patients who intent to accept RFT are those who suffer unbearable preoperative and intraoperative pain due to invalid medication, especially the severest pain which may be induced during the puncture localization of semilunar ganglion. However, there were few reports about perioperative pain management of TN patients, and most doctors haven't attached importance to perioperative pain control. With the development of society and economics, the ideal preoperative pain control becomes more and more important for perioperative patients and it is the basic right of patients to reduce pain[2]. Since medication therapy is invalid, local block has the potential to be an ideal preoperative analgesia method. Some foreign reports showed that preoperative local anesthesia can reduce patients' requirement for postoperative analgesic agents[3-4]. But there are few reports about the preoperative pain of TN patients. Closure treatment of trigeminal nerve with lidocaine can delay the onset of pain and reduce pain intensity. A foreign report suggested that preoperativeperipheral nerve block with lidocaine can alleviate patients' unbearably preoperative and intraoperative pain[5]. But lidocaine is a short-acting local anesthetic, so we found in clinical that the pain alleviation time is short. In recent years, Chinese scholars reported a more long-lasting local anesthetic, that is, compound lidocaine hydrochloride injection(CLH), which compound preparation, a sterile dilute alcohol solution consisting of lidocaine hydrochloride and menthol, etc. It is a kind of novel long-acting analgesic compound preparation that has been applied in clinical. Since its characteristics including fast onset, long-lasting analgesic effects and safety, CLH has been more and more used in clinical. Therefore, this study intends to carry out a clinical trial on peripheral trigeminal branch block with two kinds of local anesthetics, to observe the management effects of RFT on perioperative pain of TN patients. 1. To explore the characteristics of preoperative and perioperative painin TN patients with RFT of trigeminal gasserian ganglion; 2. To prospectively evaluate the analgesic effects of trigeminal block with two kinds of local anesthetics on perioperative pain and intraoperative puncture pain.Methods: This study was divided into two tests. Test one selected 40 patients with primary trigeminal neuralgia from General Hospital of Chengdu Military Region between May 2014 and August 2014. All of the patients were confirmed to the international diagnostic criteria and were intended to accept RFT of trigeminal gasserian ganglion. The severest pain intensity, average pain intensity and sleep quality of these participants were assessed 24 h before admission, 24 h before operation and 24 h after operation. Test two,90 patients with classic trigeminal neuralgia who were scheduled to undergo radiofrequency thermocoagulation of the gasserian ganglion from General Hospital of Chengdu Military Region between September 2014 and June 2015 were randomly divided into 3 groups,Control group N: without nerve block(n= 30); Group A:using 2 ml 2% lidocaine hydrochloride(n = 30); Group B:using 2ml compound lidocaine hydrochloride(n = 30)Results: In test one, 97.5% patients showed that the average pain reached middle-to-severe degree 24 h before operation, where severe pain accounted for 52.5% while middle pain accounted for 45%; 97.5% patients showed the severest pain reached middle-to-severe degree 24 h before operation, where severe pain accounted for 85% while middle pain accounted for 12.5%; sleep quality assessment showed that only 5% of the patients had normal sleep 24 h before operation, while 95% of the patients had sleep disorder, including 47.5% of the patients who woke up occasionally because of pain and 42.5% of the patients who were always awakened by the pain. In test two, the average pain and the severest pain were all significantly reduced in nerve block group A and nerve block group B at 24 h after block, compared with the values before block, and compared with the control group at the same time point; in addition, their sleep quality was also improved and the satisfaction on analgesia was increased, with statistically significant differences(P<0.01);after 48 h, the pain alleviation and sleep quality improvement of the CLH group were of statistically significant differences, compared with the condition before block and compared with the control group at the same time point(P <0.05); but there were no statistically significant difference in the lidocaine hydrochloride group(P>0.05). In addition,the nerve pain intensity before the needle reached the gasserian ganglion in the radiofrequency puncture treatment of group A and B is less than control group(P<0.05).The effect of compound lidocaine hydrochloride is more significant than lidocaine hydrochloride(P < 0.05).Conclusion: 1.The majority of patients with trigeminal neuralgia suffers the perioperative middle-to-severe pain and sleep disorders. 2.Most of the patients experience the most severe pain in the process of piercing.3. A single peripheral nerve block with Long-term narcotic compound lidocaine hydrochloride may be an effective way to relieve preoperative and peroperative intolerable pain of trigeminal neuralgia. |
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