Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA.
Int Forum Allergy Rhinol. 2012 Jul-Aug;2(4):325-30. doi: 10.1002/alr.21035. Epub 2012 Apr 5.
Over 45 million Americans suffer from recurrent headaches, and an estimated $11.9 million was spent on doctor's visits for rhinogenic pain last year. Sphenopalatine blocks have been described for various facial pain syndromes, but their use and the type of blockade agents remain controversial. The objective of this study was to demonstrate that endoscopic nerve blocks, using a mixture of bupivicaine and triamcinolone-40, injected into the anterior ethmoid or sphenopalatine regions, can be a relative safe and effective option for refractory pain.
The charts of all patients undergoing endoscopic neural blockade, in a private practice setting from 1998 to 2008 were retrospectively reviewed. A 1:1 mixture of 0.5% bupivicaine and triamcinolone acetonide injectable suspension was injected into the patients' anterior ethmoid or sphenopalatine neural distribution, or both, depending on the pain distribution. Charts were reviewed to assess outcomes and any adverse events from nerve blocks.
A total of 882 nerve blocks were administered to 147 patients, over the course of 431 office visits. Four mild complications, 2 moderate complications, and no severe or permanent complications were noted. No permanent visual complications were observed. Of all the charts, 85% had documented effects of the nerve block at follow-up. Of those, 81.3% claimed improvement, 17.9% reported feeling the same, and 0.79% stated they had worse pain.
Endoscopic neural blockade appears to be a relatively safe and viable option in the treatment of refractory headache and facial pain with a rhinogenic component.
超过 4500 万美国人患有复发性头痛，去年估计有 1190 万美元用于治疗鼻源性疼痛的医生就诊。蝶腭神经阻滞术已被用于治疗各种面部疼痛综合征，但它们的使用和阻滞剂类型仍存在争议。本研究的目的是证明在鼻内镜下，将布比卡因和曲安奈德混合液注射到额窦或蝶腭神经区域，可以作为治疗难治性疼痛的一种相对安全有效的选择。
回顾性分析了 1998 年至 2008 年在一家私人诊所接受鼻内镜神经阻滞治疗的所有患者的病历。将 0.5%布比卡因和曲安奈德可注射混悬液以 1:1 的比例混合，根据疼痛分布情况，将其注射到患者的额窦或蝶腭神经分布区域，或两者都注射。通过查看病历来评估神经阻滞的结果和任何不良反应。
共对 147 名患者的 882 次神经阻滞进行了治疗，共进行了 431 次就诊。记录到 4 例轻度并发症、2 例中度并发症，无严重或永久性并发症。未观察到永久性视力并发症。在所有的病历中，85%的患者在随访时有神经阻滞的效果记录。其中，81.3%的患者声称疼痛有所改善，17.9%的患者感觉相同，0.79%的患者表示疼痛加重。
鼻内镜下神经阻滞术似乎是治疗难治性头痛和面部疼痛伴鼻源性疼痛的一种相对安全且可行的选择。
