Weng Zelin, Zhou Xiaojun, Liu Xiaojian, Wei Jun, Xu Qingbang, Yao Shanglong
Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Craniofac Surg. 2013 Jul;24(4):1298-302. doi: 10.1097/SCS.0b013e31829428aa.
Trigeminal neuralgia is the worst pain that human beings have ever experienced. Few researches have illustrated perioperative pain in patients with trigeminal neuralgia undergoing radiofrequency thermocoagulation (RFT) of the gasserian ganglion under local anesthesia. Because there are some undeniable drawbacks of using intravenous short-term anesthesia during the intervention repeatedly, some physicians keep patients awake throughout the puncture procedure, using local anesthesia. The purpose of this investigation was to examine perioperative pain in patients with trigeminal neuralgia undergoing RFT of the gasserian ganglion. Participants were 104 patients with classic trigeminal neuralgia. Worst pain intensity, mean pain intensity, quality of sleep, and analgesia satisfaction were evaluated for 24 hours before admission, 24 hours before operation, and 24 hours after operation. Intraoperative worst pain intensity was determined. Preoperative pain was serious, and preoperative sleep quality significantly and positively correlated with preoperative mean pain (r = 0.52; P = 0.00) and worst pain (r = 0.49; P = 0.00). Few patients (1.9%) responded to preoperative treatment, and the preoperative treatment obtained low analgesia satisfaction scores (3.9 [1.3]). Most patients experienced severe pain during cannulation under local anesthesia. No patients complained of pain during radiofrequency lesioning. The RFT of the gasserian ganglion alleviated pain obviously. Most patients (94.2%) responded to the operation, and the operation got high analgesia satisfaction scores (8.9 [0.7]). The results demonstrate that preoperative pain in patients with trigeminal neuralgia undergoing RFT of the gasserian ganglion is prevalent and undertreated and that intraoperative pain is severe under local anesthesia during cannulation.
三叉神经痛是人类经历过的最剧烈的疼痛。很少有研究阐述过在局部麻醉下接受三叉神经半月节射频热凝术（RFT）的三叉神经痛患者的围手术期疼痛情况。由于在干预过程中反复使用静脉短效麻醉存在一些不可否认的缺点，一些医生在整个穿刺过程中让患者保持清醒，仅使用局部麻醉。本研究的目的是检查接受三叉神经半月节RFT的三叉神经痛患者的围手术期疼痛情况。研究对象为104例典型三叉神经痛患者。在入院前24小时、手术前24小时和手术后24小时评估最剧烈疼痛强度、平均疼痛强度、睡眠质量和镇痛满意度。确定术中最剧烈疼痛强度。术前疼痛严重，术前睡眠质量与术前平均疼痛（r = 0.52；P = 0.00）和最剧烈疼痛（r = 0.49；P = 0.00）显著正相关。很少有患者（1.9%）对术前治疗有反应，术前治疗的镇痛满意度得分较低（3.9 [1.3]）。大多数患者在局部麻醉下插管过程中经历了剧烈疼痛。在射频毁损过程中没有患者抱怨疼痛。三叉神经半月节RFT明显缓解了疼痛。大多数患者（94.2%）对手术有反应，手术的镇痛满意度得分较高（8.9 [0.7]）。结果表明，接受三叉神经半月节RFT的三叉神经痛患者术前疼痛普遍存在且治疗不足，并且在局部麻醉下插管期间术中疼痛剧烈。
