Mellick Larry B, Mellick Gary A
Department of Emergency Medicine, Medical College of Georgia, Augusta, Georgia, USA.
J Orofac Pain. 2008 Winter;22(1):57-64.
To describe 1 year's experience in treating orofacial pain with intramuscular injections of 0.5% bupivacaine bilateral to the spinous processes of the lower cervical vertebrae.
A retrospective review of 2,517 emergency department patients with discharge diagnoses of a variety of orofacial pain conditions and 771 patients who were coded as having had an anesthetic injection between June 30, 2003 and July 1, 2004 was performed. The records of all adult patients who had undergone paraspinous intramuscular injection with bupivacaine for the treatment of an orofacial pain condition were extracted from these 2 databases and included in this retrospective review. Pain relief was reported in 2 different ways: (1) patients (n = 114) were placed in 1 of 4 orofacial pain relief categories based on common clinical experience and face validity and (2) pain relief was calculated based on patients' (n = 71) ratings of their pain on a numerical descriptor scale before and after treatment.
Lower cervical paraspinous intramuscular injections with bupivacaine were performed in 118 adult patients. Four charts were excluded from review because of missing or inadequate documentation. Pain relief (complete or clinical) occurred in 75 patients (66%), and partial orofacial pain relief in 32 patients (28%). No significant relief was reported in 7 patients (6%). Overall, some therapeutic response was reported in 107 of 114 patients (94%). Orofacial pain relief was rapid, with many patients reporting complete relief within 5 to 15 minutes.
This is the first report of a large case series of emergency department patients whose orofacial pain conditions were treated with intramuscular injections of bupivacaine in the paraspinous muscles of the lower neck. The findings suggest that lower cervical paraspinous intramuscular injections with bupivacaine may prove to be a new therapeutic option for acute orofacial pain in the emergency department setting.
描述在颈椎下段棘突双侧肌内注射0.5%布比卡因治疗口面部疼痛的1年经验。
对2003年6月30日至2004年7月1日期间2517例出院诊断为各种口面部疼痛疾病的急诊科患者以及771例编码为接受过麻醉注射的患者进行回顾性研究。从这两个数据库中提取所有接受过布比卡因椎旁肌内注射治疗口面部疼痛疾病的成年患者的记录，并纳入本回顾性研究。疼痛缓解情况通过两种不同方式报告：（1）根据常见临床经验和表面效度，将患者（n = 114）分为4种口面部疼痛缓解类别之一；（2）根据患者（n = 71）治疗前后在数字描述量表上的疼痛评分计算疼痛缓解情况。
118例成年患者接受了颈椎下段椎旁肌内注射布比卡因治疗。由于记录缺失或不充分，4份病历被排除在研究之外。75例患者（66%）疼痛完全缓解或临床缓解，32例患者（28%）口面部疼痛部分缓解。7例患者（6%）报告无明显缓解。总体而言，114例患者中有107例（94%）报告有某种治疗反应。口面部疼痛缓解迅速，许多患者报告在5至15分钟内完全缓解。
这是关于急诊科大量病例系列的首份报告，这些患者的口面部疼痛疾病通过在下颈部椎旁肌内注射布比卡因进行治疗。研究结果表明，颈椎下段椎旁肌内注射布比卡因可能成为急诊科急性口面部疼痛的一种新治疗选择。
