Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Pain Pract. 2020 Nov;20(8):850-858. doi: 10.1111/papr.12910. Epub 2020 Jun 30.
Although pulsed radiofrequency (PRF) has few postoperative adverse reactions, its analgesic efficacy for trigeminal neuralgia (TN) is not always guaranteed. The response rate of PRF targeting the Gasserian ganglion for patients with TN varies. This study aims to identify the predictors of the analgesic efficacy of CT-guided percutaneous PRF in patients with idiopathic TN.
The patients with idiopathic TN who failed to respond to conservative treatment and underwent CT-guided percutaneous PRF treatment of the Gasserian ganglion from July 2008 to August 2018 at our pain clinic were screened. A positive response was defined as a ≥50% reduction in the pain numeric rating scale (NRS) score from baseline. The demographics and other pretreatment clinical data were analyzed by logistic regression analysis to identify the predictors of a positive response.
Of the total 102 patients with idiopathic TN who were evaluated in this study, 57 patients (55.9%) were positively responsive to our treatment after 1 year. The binary logistic regression analysis revealed that the positive response to a prior peripheral branch nerve block of the trigeminal nerve with steroid and local anesthetic agents was an independent predictor of the analgesic efficacy of PRF treatment (odds ratio [OR] = 3.685, 95% confidence interval [CI] = 1.583 to 8.577, P = 0.002). The disease duration of TN was also included in the multivariate regression model, although the P value was 0.058 (OR 0.807, 95% CI 0.646 to 1.007).
For patients who previously had positive responses to peripheral branch nerve block of the trigeminal nerve, PRF is likely to have better efficacy.
虽然脉冲射频（PRF）术后不良反应较少，但对三叉神经痛（TN）的镇痛效果并不总是有保证。PRF 治疗三叉神经节的反应率因患者而异。本研究旨在确定 CT 引导下经皮 PRF 治疗特发性 TN 患者的镇痛效果的预测因素。
从 2008 年 7 月至 2018 年 8 月，在我们的疼痛诊所对经保守治疗无效的特发性 TN 患者进行了 CT 引导下经皮 PRF 治疗三叉神经节的筛选。阳性反应定义为疼痛数字评分量表（NRS）基线评分至少降低 50%。通过逻辑回归分析对患者的人口统计学和其他治疗前临床数据进行分析，以确定阳性反应的预测因素。
在本研究中评估的 102 例特发性 TN 患者中，有 57 例（55.9%）在 1 年后对我们的治疗有阳性反应。二项逻辑回归分析显示，先前使用类固醇和局部麻醉剂的三叉神经周围分支神经阻滞的阳性反应是 PRF 治疗镇痛效果的独立预测因素（比值比[OR] = 3.685，95%置信区间[CI] = 1.583 至 8.577，P = 0.002）。尽管 TN 病程也纳入了多变量回归模型，但 P 值为 0.058（OR 0.807，95% CI 0.646 至 1.007）。
对于先前对三叉神经周围分支神经阻滞有阳性反应的患者，PRF 可能更有效。
