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Ruscheweyh R, Gierthmühlen J, Hedderich DM, Goßrau G, Leis S. [Trigeminal neuralgia: drug therapy : The new German guideline]. Schmerz 2024; 38:283-292. [PMID: 38689064 DOI: 10.1007/s00482-024-00810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 05/02/2024]
Abstract
Trigeminal neuralgia is characterized by severe, lightning-like attacks of pain, which are mandatory for the diagnosis. The pain typically occurs on one side and is often triggered by simply touching the face, chewing or talking. In acute exacerbations, this can also hinder food and fluid intake, resulting in a life-threatening clinical picture. A distinction is made between classical, secondary and idiopathic trigeminal neuralgia. For the diagnosis of trigeminal neuralgia, the medical history and imaging procedures are key for classification. The only active substances approved for the treatment of trigeminal neuralgia in Germany are carbamazepine and phenytoin, which is why off-label drugs often need to be used if there is no or insufficient effect or inacceptable side effects. Cooperation between research and clinical practice to improve the care of affected patients is therefore essential.
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Affiliation(s)
- Ruth Ruscheweyh
- Neurologische Klinik und Poliklinik, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Janne Gierthmühlen
- Interdisziplinäres Zentrum für Schmerz- und Palliativmedizin, Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Dennis M Hedderich
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, School of Medicine and Health, Technische Universität München, München, Deutschland
| | - Gudrun Goßrau
- Kopfschmerzambulanz, Interdisziplinäres UniversitätsSchmerzCentrum, Medizinische Fakultät, Universitätsklinikum Dresden, TU Dresden, Dresden, Deutschland
| | - Stefan Leis
- Christian-Doppler-Klinik, Universitätsklinik für Neurologie, neurologische Intensivmedizin und Neurorehabilitation, Paracelsus Medizinische Universität, Salzburg, Österreich
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Maeda A, Chikama Y, Tanaka R, Tominaga M, Shirozu K, Yamaura K. Safety and utility of ultrasound-guided superior cervical ganglion block for headaches and orofacial pain: a retrospective, single-center study of 10 patients. JA Clin Rep 2023; 9:21. [PMID: 37119368 PMCID: PMC10148940 DOI: 10.1186/s40981-023-00613-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Several new ultrasound-guided superior cervical ganglia blocks (U-SCGBs) have been proposed to overcome the shortcomings of conventional superior cervical ganglia blocks; however, their clinical utility and practicality have not yet been demonstrated. The aim of this study was to evaluate the safety and utility of a new method of U-SCGB. METHODS We retrospectively collected data on patients who underwent U-SCGB for the treatment of headaches and orofacial pain at a single center. U-SCGB was performed by injecting 2-3 mL of 1% mepivacaine posterior to the internal carotid artery, just above the bifurcation. The Wilcoxon signed-rank test was used to compare pain scores. Numerical data are expressed as the mean ± standard error. RESULTS The total number of U-SCGB procedures was 43. All procedures were accompanied by Horner's sign. The numerical rating scale score for pain (possible scores, 0-10) was reduced predominantly from 7.0 ± 0.7 before treatment to 4.5 ± 0.7 at the follow-up (p = 0.014). CONCLUSION U-SCGB was considered a clinically useful and accurate treatment for headaches and orofacial pain in this study.
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Affiliation(s)
- Aiko Maeda
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maedashi, Higashi-Ku, Fukuoka City, 812-8582, Japan.
| | - Yoji Chikama
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maedashi, Higashi-Ku, Fukuoka City, 812-8582, Japan
| | - Ryudo Tanaka
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maedashi, Higashi-Ku, Fukuoka City, 812-8582, Japan
| | | | - Kazuhiro Shirozu
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maedashi, Higashi-Ku, Fukuoka City, 812-8582, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan
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Wandrey JD, Kastelik J, Fritzsche T, Denke C, Schäfer M, Tafelski S. Supplementing transcranial direct current stimulation to local infiltration series for refractory neuropathic craniocephalic pain: A randomized controlled pilot trial. Front Neurol 2023; 14:1069434. [PMID: 36937523 PMCID: PMC10014889 DOI: 10.3389/fneur.2023.1069434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/07/2023] [Indexed: 03/05/2023] Open
Abstract
Background Some patients with neuralgia of cranial nerves with otherwise therapy-refractory pain respond to invasive therapy with local anesthetics. Unfortunately, pain regularly relapses despite multimodal pain management. Transcranial direct current stimulation (tDCS) may prolong pain response due to neuro-modulatory effects. Methods This controlled clinical pilot trial randomized patients to receive anodal, cathodal or sham-tDCS stimulation prior to local anesthetic infiltration. Pain attenuation, quality-of-life and side effects were assessed and compared with historic controls to estimate effects of tDCS stimulation setting. Results Altogether, 17 patients were randomized into three groups with different stimulation protocols. Relative reduction of pain intensity in per protocol treated patients were median 73%, 50% and 69% in anodal, cathodal and sham group, respectively (p = 0.726). Compared with a historic control group, a lower rate of responders with 50% reduction of pain intensity indicates probable placebo effects (OR 3.41 stimulation vs. non-stimulation setting, NNT 3.63). 76.9% (n = 10) of tDCS patients reported mild side-effects. Of all initially included 17 patients, 23.5% (n = 4) withdrew their study participation with highest proportion in the cathodal group (n = 3). A sample size calculation for a confirmatory trial revealed 120 patients using conservative estimations. Discussion This pilot trial does not support series of anodal tDCS as neuro-modulatory treatment to enhance pain alleviation of local anesthetic infiltration series. Notably, results may indicate placebo effects of tDCS settings. Feasibility of studies in this population was limited due to relevant drop-out rates. Anodal tDCS warrants further confirmation as neuro-modulatory pain treatment option.
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Ruscheweyh R, Lutz J, Mehrkens JH. [Trigeminal neuralgia : Modern diagnostic workup and treatment]. Schmerz 2020; 34:486-494. [PMID: 32960312 DOI: 10.1007/s00482-020-00496-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 12/23/2022]
Abstract
The present article gives an update of relevant aspects in the diagnosis and therapy of trigeminal neuralgia from the neurological, neuroradiological and neurosurgical point of view. The diagnosis of trigeminal neuralgia is clinical, but high-quality imaging is mandatory to identify secondary causes and a neurovascular contact. New methods such as DTI (diffusion tensor imaging) allow a more differentiated assessment of the consequences of a vascular contact on the trigeminal nerve. Carbamazepine and oxcarbazepine continue to be first choice for the medical treatment, but have been supplemented by additional options such as pregabaline, lamotrigine, and onabotulinumtoxin A. In patients insufficiently responding to medical treatment, there are neurosurgical treatment options giving very good results. The best long-term results have been described for microvascular decompression, but percutaneous and radiosurgical treatments also are good options, especially in patients with an increased surgical risk profile, in secondary trigeminal neuralgia, and in case of recurrence after microvascular decompression.
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Affiliation(s)
- Ruth Ruscheweyh
- Neurologische Klinik, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Jürgen Lutz
- Radiologisches Zentrum München (RZM), Pippingerstr. 25, 81245, München, Deutschland
| | - Jan-Hinnerk Mehrkens
- Neurochirurgische Klinik, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
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Retrospective Study on Ganglionic and Nerve Block Series as Therapeutic Option for Chronic Pain Patients with Refractory Neuropathic Pain. Pain Res Manag 2020; 2020:6042941. [PMID: 32774567 PMCID: PMC7399767 DOI: 10.1155/2020/6042941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/03/2020] [Accepted: 06/13/2020] [Indexed: 11/18/2022]
Abstract
Objective Current recommendations controversially discuss local infiltration techniques as specific treatment for refractory pain syndromes. Evidence of effectiveness remains inconclusive and local infiltration series are discussed as a therapeutic option in patients not responding to standard therapy. The aim of this study was to investigate the effectiveness of infiltration series with techniques such as sphenopalatine ganglion (SPG) block and ganglionic local opioid analgesia (GLOA) for the treatment of neuropathic pain in the head and neck area in a selected patient group. Methods In a retrospective clinical study, 4960 cases presenting to our university hospital outpatient pain clinic between 2009 and 2016 were screened. Altogether, 83 patients with neuropathic pain syndromes receiving local infiltration series were included. Numeric rating scale (NRS) scores before, during, and after infiltration series, comorbidity, and psychological assessment were evaluated. Results Maximum NRS before infiltration series was median 9 (IQR 8–10). During infiltration series, maximum NRS was reduced by mean 3.2 points (SD 3.3, p < 0.001) equaling a pain reduction of 41.0% (SD 40.4%). With infiltration series, mean pain reduction of at least 30% or 50% NRS was achieved in 54.2% or 44.6% of cases, respectively. In six percent of patients, increased pain intensity was noted. Initial improvement after the first infiltration was strongly associated with overall improvement throughout the series. Conclusion This study suggests a beneficial effect of local infiltration series as a treatment option for refractory neuropathic pain syndromes in the context of a multimodal approach. This effect is both significant and clinically relevant and therefore highlights the need for further randomized controlled trials.
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Carcamo CR, Hormazabal FA, Gutierrez FI, Carmona AP. Pulsed radiofrequency of superior cervical ganglion for treatment of painful post-traumatic trigeminal neuropathy (PTTN): A case series report. Cranio 2019; 40:166-173. [PMID: 31726950 DOI: 10.1080/08869634.2019.1692284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Painful post-traumatic trigeminal neuropathy (PTTN) is a clinical pain syndrome that occurs due to injuries to the peripheral branches of the trigeminal nerve and is characterized by a deep burning pain and accompanied by positive and negative neurological signs. In patients with recalcitrant PTTN, the sympathetic nervous system is a potential therapeutic target. The aim of this study was to investigate the therapeutic response of PTTN patients to pulsed radiofrequency treatment (PRF) of the superior cervical sympathetic ganglion (SCG).Methods: Thirty-five patients with PTTN who had a history of severe disabling facial neuropathic pain underwent PRF of the SCG under a new lateral fluoroscopic approach.Results: The patients' pain intensity post-PRF was 3.94 (± 3.11), compared with 8.82 (± 1.27) pre-PRF (p < .001).Conclusion: PRF of the SCG could be an effective method to treat chronic PTTN.
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Affiliation(s)
- Cesar R Carcamo
- Chronic Pain Unit, Clinica Alemana, Clinica Davila, Chile, Faculty of Medicine, Universidad del Desarrollo, Santiago, Chile
| | - Fernando A Hormazabal
- Pain Unit, Mutual de Seguridad Hospital, Chile, School of Dentistry, Faculty of Medicine, Pontificia Universidad, Católica de Chile, Santiago, Chile
| | - Felipe I Gutierrez
- Maxillofacial Surgery and Traumatology, Universidad Mayor, Santiago, Chile
| | - Andrea P Carmona
- Maxillofacial Surgery and Traumatology, Mutual de Seguridad Hospital, Santiago, Chile
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[Trigeminal neuralgia: treatment options for refractory cases]. MMW Fortschr Med 2019; 161:52-56. [PMID: 31129820 DOI: 10.1007/s15006-019-0557-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Yang J, Choi Y, Park J, Jeong J, Lee B, Lee K, Lee J, Choi R. Reversible Horner's syndrome after cervical spinal cord stimulator implantation in a patient with complex regional pain syndrome. J Pain Res 2018; 11:3019-3023. [PMID: 30568482 PMCID: PMC6267498 DOI: 10.2147/jpr.s182345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We successfully performed cervical spinal cord stimulator (SCS) surgery in a 27-year-old man with complex regional pain syndrome to control intractable pain. The SCS trial was performed twice to adjust the SCS coverage region. After permanent implantation surgery, the patient developed Horner's syndrome when the region near the C4 spinal dorsal root was stimulated. However, Horner's syndrome disappeared after changing the stimulation leads. This case report suggests that cervical SCS can be associated with superior cervical ganglion stimulation.
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Affiliation(s)
- Jaeyoung Yang
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea,
| | - Yusun Choi
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea,
| | - Juyoung Park
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea,
| | - Junhyug Jeong
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea,
| | - Bousung Lee
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea,
| | - Kwanghaeng Lee
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea,
| | - Jaedo Lee
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea,
| | - Rakmin Choi
- Department of Anesthesiology and Pain Medicine, Veterans Health Service Medical Center, Seoul, South Korea,
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Extensive Craniocervical Abscess after Transoral Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion for Atypical Trigeminal Neuralgia: Report of a Severely Complicated Case. Case Rep Med 2018; 2018:5247594. [PMID: 29977303 PMCID: PMC5994273 DOI: 10.1155/2018/5247594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/07/2018] [Accepted: 03/27/2018] [Indexed: 11/17/2022] Open
Abstract
Ganglionic local opioid analgesia (GLOA) describes the application of low-dose opioids close to sympathetic as, for example, to the superior cervical ganglion. GLOA can be effective in different pain syndromes affecting the head and face region and has been considered to be a safe technique with few complications reported so far. We present the case of a patient who received a single, transoral GLOA for a refractory trigeminal neuralgia. The patient subsequently developed an extensive epidural abscess at the craniocervical junction, requiring ultimately transoral odontoid resection and dorsal stabilisation. This severe complication challenges the role of transoral infiltration therapies in analgetic medicine.
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Carcamo CR. Pulsed Radiofrequency of Superior Cervical Sympathetic Ganglion for Treatment of Refractory Migraine. PAIN MEDICINE 2017; 18:1598-1600. [PMID: 28057810 DOI: 10.1093/pm/pnw301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Cesar R Carcamo
- Chronic Pain Unit, Mutual de Seguridad Hospital, Santiago City, Chile
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Mitsuoka K, Kikutani T, Sato I. Morphological relationship between the superior cervical ganglion and cervical nerves in Japanese cadaver donors. Brain Behav 2017; 7:e00619. [PMID: 28239529 PMCID: PMC5318372 DOI: 10.1002/brb3.619] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/25/2016] [Accepted: 11/05/2016] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION There are various communications between the superior cervical ganglion (SCG) and the vagus and glossopharyngeal nerves. However, little information exists concerning the origin of these sympathetic ganglion branches at the superior, middle, and inferior regions of the human SCG. The aim of this study was to describe the human SCG in a morphometric manner with the communication with cranial and cervical nerves and supply. METHODS This study characterized 72 SCG samples from 54 elderly Japanese human cadavers (30 males, 24 females; 65-100 years old). The SCG size (length, width, and thickness) and location were measured from the jugular foramen. We also defined the communication branches of the SCG to the vagus, glossopharyngeal, cervical, and accessory nerves at three regions (superior, middle, and inferior regions) of the SCG. Finally, we examined the arrangement and origin of the branch communications in detail and confirmed our observations, using histological sections of the SCG. RESULTS The SCG in all cadaver donors was detected at the C2 and C3 vertebra levels. The number of SCG branches supplied the communicating branches, such as the carotid branch, communicating branch of the vagus nerve, and glossopharyngeal nerve, were frequently detected in the superior region of the SCG (χ2 = 587.72, df = 26, p < .001). The number of ganglion cells with a large number of neurons per unit area (1 mm2) was most often found in the middle region with shrunken neurons of the SCG compared with other regions. CONCLUSION The communication branches of the SCG are mainly connected to the vagus and glossopharyngeal nerves. Characterizing these branches can provide useful data for head and neck ganglion block and surgical treatments.
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Affiliation(s)
- Kazuyuki Mitsuoka
- Department of Anatomy The Nippon Dental University School of Life Dentistry at Tokyo Tokyo Japan; Division of Clinical Oral Rehabilitation The Nippon Dental University Graduate School of Life Dentistry Tokyo Japan
| | - Takeshi Kikutani
- Department of Clinical Oral Rehabilitation The Nippon Dental University School of Life Dentistry at Tokyo Tokyo Japan
| | - Iwao Sato
- Department of Anatomy The Nippon Dental University School of Life Dentistry at Tokyo Tokyo Japan
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A morphometric analysis of the superior cervical ganglion and its surrounding structures. Surg Radiol Anat 2015; 38:299-302. [PMID: 26364034 DOI: 10.1007/s00276-015-1551-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this cadaveric study was to detect the superior cervical ganglion (SCG) in a topographic manner according to vertebrae and to determine the relationship between the vertebrae, mandibular angle and longus colli muscle through morphometric analysis. METHODS The present study was performed on 40 SCG of 20 human cadavers (16 males, 4 females). The level of the SCG was determined based on the vertebrae. Ganglion length, width and thickness were detected. Distance to the adjacent vertebra, the mandibular angle and medial side of the longus colli muscle were measured. The results were evaluated statistically. RESULTS The SCG existing in all cadavers was detected at the C2 vertebra level in 34 cadavers and at the C3 vertebra level in 6 cadavers. The average length, width and thickness of the SCG were 15.18 ± 1.12, 4.62 ± 0.25, and 1.83 ± 0.10 mm, respectively. No statistically significant difference was detected in terms of the distances between the ganglion and anterior tubercle of transverse processes of the vertebrae as well as the mandibular angle on either side. The distance between the SCG and the medial edge of the longus colli muscle was significantly greater on the left side in both men (p < 0.001) and women (p < 0.01). CONCLUSION Recognition of morphometric characteristics of the SCG and detection of its location according to adjacent formations may serve as a guide for nerve blockage studies and help surgeons to preserve the ganglion in both anterior and anterolateral cervical approaches.
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Siegenthaler A, Haug M, Eichenberger U, Suter MR, Moriggl B. Block of the Superior Cervical Ganglion, Description of a Novel Ultrasound-Guided Technique in Human Cadavers. PAIN MEDICINE 2013; 14:646-9. [DOI: 10.1111/pme.12061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
We report the case of a 39-year-old female patient who suffered from trigeminal neuralgia of the left lingual nerve for 6 years. The previous therapy according to the guidelines including a Jannetta operation was unsuccessful. Only after beginning with daily mastication and consumption of very hot chilli peppers has the patient become reliably pain-free.
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Affiliation(s)
- J Loeser
- Schmerzzentrum, Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland.
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Abstract
The incidence of trigeminal neuralgia (TN) is 4.3 per 100,000 persons per year, with a slightly higher incidence for women (5.9/100,000) compared with men (3.4/100,000). There is a lack of certainty regarding the aetiology and pathophysiology of TN. The treatment of TN can be very challenging despite the numerous options patients and physicians can choose from. This multitude of treatment options poses the question as to which treatment fits which patient best. The preferred medical treatment for TN consists of anticonvulsant drugs, muscle relaxants and neuroleptic agents. Large-scale placebo-controlled clinical trials are scarce. For patients refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife surgery and microvascular decompression are the most promising invasive treatment options.
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Affiliation(s)
- Mark Obermann
- Department of Neurology University of Duisburg-Essen Hufelandstrasse 55, 45122 Essen, Germany
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Böttger E, Diehlmann K. [Selected interventional methods for the treatment of chronic pain: Part 1: peripheral nerve block and sympathetic block]. Anaesthesist 2011; 60:479-91; quiz 492. [PMID: 21553139 DOI: 10.1007/s00101-011-1890-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Approximately 5-8 million people in Germany suffer from chronic pain. Some patients can obtain relief from specific interventional techniques. In detail these are blocks of the sympathetic chain and peripheral nerve blocks, regional anesthetic techniques close to the spinal cord and neuromodulation. Part 1 of this article presents peripheral nerve blocks using the example of intercostal blocks and blocks of the sympathetic chain. Peripheral nerve blocks are important for postoperative pain treatment. Only a few methods are used for chronic pain and this applies primarily to the intercostal block which is used for the treatment of pain occurring after thoracotomy, intercostal neuralgia and pain associated with infiltration of cancer. Blocks of the vegetative nervous system are accomplished on the ganglions of the head and the sympathetic chain and are therefore most commonly applied to treat headache, neuropathic and sympathetic pain in the area of abdomen and the extremities.
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Affiliation(s)
- E Böttger
- Klinik für Anaesthesie, Operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Giessen und Marburg, Standort Giessen, Deutschland.
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Abstract
Glossopharyngeal neuralgia is a rare condition and the origin is mostly idiopathic. Causes of symptomatic glossopharyngeal neuralgia can be tumors, infarction or trauma. We report the case of a 28-year-old patient who developed glossopharyngeal neuralgia after resection of a glossopharyngeal schwannoma, which is an extremely rare tumor. Treatment consisted of orally administered pregabalin and a series of injections of buprenorphine in the superior cervical ganglion (ganglionic local opioid application/analgesia, GLOA) which led to a substantial decrease in the frequency of pain attacks. This improvement was maintained at 1-year follow-up. This is the first report of development of glossopharyngeal neuralgia after resection of a glossopharyngeal schwannoma.
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Feigl G, Anderhuber F, Fasel JHD, Likar R. Die Bedeutung der Fascia stylopharyngea bei intraoralen Blockadetechniken. Schmerz 2007; 21:28, 30-3. [PMID: 16915368 DOI: 10.1007/s00482-006-0497-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The almost unknown stylopharyngeal fascia may be one of the reasons for unsuccessful therapy of the trigeminal neuralgia by a transoral block of the superior ganglion of the sympathetic trunk. We investigated the anatomy of the fascia to show the efficiency of the block for this therapy. MATERIALS AND METHODS 103 halves of human heads were investigated. The stylopharyngeal fascia was dissected by a lateral approach. We classified three groups. Group A was formed by fascias without perforation, group B by perforated fascias and group C by all halves without a developed fascia. RESULTS We found a fully developed fascia in 86 cases. 13 halves had perforated fascias; in 4 cases the fascia was not developed. CONCLUSION The stylopharyngeal fascia may inhibit the distribution of opoids into the infratemporal fossa associated with a consecutive block of the mandibular nerve and lower the rate of pain relief.
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Affiliation(s)
- G Feigl
- Division für Anatomie im Department für Morphologie, CMU der Universität Genf.
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