Zhi Dou, Guo Yuna, He Liangliang, Yang Liqiang
Xuanwu Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2023 May 17;14:1144034. doi: 10.3389/fneur.2023.1144034. eCollection 2023.
Trigeminal neuralgia is a debilitating condition that can significantly impair the quality of life of affected individuals. Percutaneous balloon compression (PBC) has been established as an effective treatment for this condition. However, the use of general anesthesia during the procedure poses challenges to achieving the desired degree of nerve damage without causing excessive numbness. In this study, we aimed to evaluate the feasibility and efficacy of performing PBC under conscious sedation of local anesthesia.
We improved the surgical procedure for PBC by administering intraganglionic lidocaine 0.2% with fine needle aspiration to achieve conscious sedation. This allowed the operator to determine the degree of nerve damage in real time through the tactile test. We conducted a clinical observation of 87 patients who underwent PBC under conscious sedation of local anesthesia. We evaluated the intraoperative blood pressure and heart rate changes, postoperative facial pain relief, and occurrence of complications such as severe facial numbness, irreversible keratitis, vision loss, and masticatory muscle weakness.
All 87 patients achieved immediate relief of facial pain after undergoing PBC under conscious sedation of local anesthesia. The intraoperative blood pressure and heart rate changes were <20% of the baseline value. No patient experienced severe facial numbness or developed irreversible keratitis, vision loss, or masticatory muscle weakness.
Our findings suggest that PBC under wide-awake local anesthesia is a safe and effective treatment for trigeminal neuralgia. The use of conscious sedation of local anesthesia during the procedure allows the operator to achieve the desired degree of nerve damage without causing excessive numbness. This can lead to long-term pain relief and improved quality of life for patients with trigeminal neuralgia.
三叉神经痛是一种使人衰弱的疾病，会严重损害患者的生活质量。经皮球囊压迫术（PBC）已被确立为治疗该疾病的有效方法。然而，手术过程中使用全身麻醉在不引起过度麻木的情况下达到所需神经损伤程度方面存在挑战。在本研究中，我们旨在评估在局部麻醉清醒镇静下进行PBC的可行性和有效性。
我们通过用细针抽吸给予0.2%神经节内利多卡因来改进PBC手术程序以实现清醒镇静。这使操作者能够通过触觉测试实时确定神经损伤程度。我们对87例在局部麻醉清醒镇静下接受PBC的患者进行了临床观察。我们评估了术中血压和心率变化、术后面部疼痛缓解情况以及严重面部麻木、不可逆角膜炎、视力丧失和咀嚼肌无力等并发症的发生情况。
所有87例患者在局部麻醉清醒镇静下接受PBC后均立即缓解了面部疼痛。术中血压和心率变化<基线值的20%。没有患者出现严重面部麻木或发生不可逆角膜炎、视力丧失或咀嚼肌无力。
我们的研究结果表明，在完全清醒的局部麻醉下进行PBC是治疗三叉神经痛的一种安全有效的方法。手术过程中使用局部麻醉清醒镇静使操作者能够在不引起过度麻木的情况下达到所需的神经损伤程度。这可以为三叉神经痛患者带来长期的疼痛缓解并改善生活质量。
