Guo Gangwen, Li Dan, Li Hongyan, Hu Rong, Zhou Haocheng
Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.
Department of Anesthesiology, The Third Xiangya Hospital, Central South University, Changsha, 410013, China.
J Med Case Rep. 2025 Jan 17;19(1):18. doi: 10.1186/s13256-025-05033-4.
Interventional therapy of trigeminal neuropathic pain has been well documented; however, intraoperative monitoring and management of pain hypersensitivity remains barely reported, which may pose a great challenge for pain physicians as well as anesthesiologists.
A 77-year-old Han Chinese male, who suffered from severe craniofacial postherpetic neuralgia, underwent pulsed radiofrequency of trigeminal ganglion in the authors' department twice. The authors successfully placed a radiofrequency needle through the foramen ovale during the first procedure with local anesthesia and intravenous sedation (dexmedetomidine). The patient reported about 50% pain reduction postoperatively, and the second procedure was performed 1 week later. However, the intraoperative administration of sedative agents was suspended owing to hemodynamic instability during the second session. As a result, the patient displayed hypersensitivity to the percutaneous operation under local anesthesia and the authors failed to place the needle inside the Meckel's cave for uncontrollable breakthrough pain. The patient still needed to take oral medication for pain control, oxycodone (10-20 mg, every 12 hours) and pregabalin (75 mg, two times a day) in the last follow-up at 1.5 years after discharge.
The authors report a failure case of percutaneous puncturing operation with trigeminal neuropathic pain, potentially caused by intraoperative sensitization. It is essential to monitor and prevent hypersensitivity to both innoxious and noxious stimuli in patients with neuropathic pain syndrome, especially at surgical sites close to the area of nerve injury.
三叉神经病理性疼痛的介入治疗已有充分文献记载；然而，术中疼痛超敏反应的监测与管理仍鲜有报道，这可能给疼痛科医生和麻醉医生带来巨大挑战。
一名77岁的汉族男性，患有严重的颅面部带状疱疹后神经痛，在作者所在科室接受了两次三叉神经节脉冲射频治疗。作者在第一次手术中，在局部麻醉和静脉镇静（右美托咪定）下成功将射频针经卵圆孔置入。患者术后疼痛减轻约50%，1周后进行了第二次手术。然而，由于第二次手术期间血流动力学不稳定，术中暂停了镇静剂的使用。结果，患者对局部麻醉下的经皮操作表现出超敏反应，作者未能将针置入梅克尔腔，因为出现了无法控制的突破性疼痛。出院后1.5年的最后一次随访中，患者仍需口服药物控制疼痛，服用羟考酮（10 - 20毫克，每12小时一次）和普瑞巴林（75毫克，每日两次）。
作者报告了一例三叉神经病理性疼痛经皮穿刺手术失败的病例，可能是由术中致敏引起的。对于患有神经病理性疼痛综合征的患者，尤其是在靠近神经损伤区域的手术部位，监测和预防对无害和有害刺激的超敏反应至关重要。
