Keimyung University DongSan Hospital Department of Anesthesiology and Pain Medicine, Dalseo-gu, Daegu, Korea.
Pain Physician. 2022 Oct;25(7):E1057-E1062.
Radiofrequency thermocoagulation (RFT) of the trigeminal ganglion is an excellent treatment option for medically intractable trigeminal neuralgia. However, this procedure can manifest abrupt changes in cardiovascular responses. With abrupt cardiovascular changes, a sudden trigeminocardiac reflex can occur during RFT of the trigeminal ganglion.
The primary endpoint of this study was to identify the critical point at which RFT causes abrupt hemodynamic response changes. The secondary endpoint of this study was to evaluate the occurrence of the trigeminocardiac reflex.
Retrospective design.
An interventional pain management practice in The Republic of Korea (South Korea).
Forty patients who received trigeminal ganglion RFT under C-arm guidance due to intractable facial pain were included. We checked and recorded the blood pressure and heart rate at baseline (before RFT), immediately before and after entering the foramen ovale (FO), during electrical stimulation, during thermal heating, and 30 minutes post-RFT. Also, we recorded the presence or absence of the trigeminocardiac reflex during RFT.
Heart rate during thermal heating increased more than 20% compared to baseline (87.6 beats/min vs 69 beats/min, P < 0.001). The mean arterial pressure showed an increase of more than 15% compared to baseline when the cannula entered the FO (106.4 mmHg vs 90.9 mmHg, P < 0.001) and during thermal heating (106.3 mmHg vs 90.9 mmHg, P < 0.001). Sudden bradycardia was observed in 25% (10/40) of the patients. Among 10 patients who showed sudden bradycardia, it was observed when the cannula entered the FO (15%, 6/40), during electrical stimulation (5%, 2/40), and during heating (5%, 2/40).
This study included 40 patients who received trigeminal ganglion RFT, which is a low number to clarify the real incidence of the trigeminocardiac reflex during RFT.
FO puncturing, electrical stimulation, and thermal heating demonstrated an abrupt increase in heart rate and mean arterial pressure. The incidence of sudden bradycardia during RFT of the trigeminal ganglion was 25%. Most cases of bradycardia were observed during FO puncturing.
射频热凝（RFT）治疗三叉神经节是治疗药物难治性三叉神经痛的一种极好的选择。然而，该手术可能会导致心血管反应的急剧变化。由于心血管的急剧变化，在三叉神经节的 RFT 过程中可能会突然发生三叉心反射。
本研究的主要终点是确定 RFT 引起血流动力学急剧变化的临界点。本研究的次要终点是评估三叉心反射的发生情况。
回顾性设计。
韩国一家介入性疼痛管理诊所。
纳入 40 例因面部疼痛接受 C 臂引导下三叉神经节 RFT 的患者。我们在 RFT 前（基础状态）、进入卵圆孔（FO）前即刻、进入 FO 时、电刺激时、热加热时以及 RFT 后 30 分钟检查并记录血压和心率。此外，我们还记录了 RFT 过程中是否发生了三叉心反射。
与基础状态相比，热加热时心率增加超过 20%（87.6 次/分比 69 次/分，P < 0.001）。当套管进入 FO 时（106.4mmHg 比 90.9mmHg，P < 0.001）和在热加热时（106.3mmHg 比 90.9mmHg，P < 0.001），平均动脉压比基础状态增加超过 15%。25%（10/40）的患者出现突然心动过缓。在 10 例出现突然心动过缓的患者中，有 6 例（15%，6/40）发生在套管进入 FO 时，2 例（5%，2/40）发生在电刺激时，2 例（5%，2/40）发生在加热时。
本研究纳入了 40 例接受三叉神经节 RFT 的患者，数量较少，无法明确 RFT 过程中三叉心反射的真实发生率。
FO 穿刺、电刺激和热加热均表现为心率和平均动脉压的急剧升高。三叉神经节 RFT 过程中突然心动过缓的发生率为 25%。大多数心动过缓发生在 FO 穿刺时。
