Therapeutics and Clinical Risk Management (Dec 2022)
The Effect of Trigeminal Ganglion Block on Trigeminocardiac Reflex in Elderly Patients with Trigeminal Neuralgia Undergoing Percutaneous Balloon Compression: A Randomized Controlled Study
Abstract
Huanhuan Zhang,1 Meinv Liu,1 Wenchang Guo,2 Jinhua He,1 Jianli Li1 1Department of Anesthesiology, Hebei General Hospital, Shijiazhuang City, Hebei Provence, People’s Republic of China; 2Department of Neurosurgery, Hebei General Hospital, Shijiazhuang City, Hebei Provence, People’s Republic of ChinaCorrespondence: Jianli Li, Department of Anesthesiology, Hebei General Hospital, 348 Heping Road West, Shijiazhuang, Hebei Province, 050051, People’s Republic of China, Tel +86 311 8598 8447, Email [email protected]: Trigeminal neuralgia (TN) is a facial neuropathic pain, which is defined as unilateral brief shock-like paroxysmal pain. Percutaneous balloon compression (PBC) was widely used to treat TN under general anesthesia. However, trigeminocardiac reflex (TCR) as a brainstem reflex can induce bradycardia or even cardiac arrest during PBC, which may result in catastrophic consequences in elderly patients. The aim of the present study was to investigate the effect of trigeminal ganglion block on TCR in elderly patients with TN during PBC.Materials and Methods: Eighty-two elderly patients undergoing PBC were recruited to this randomized controlled study. The participants were randomly allocated to the control group (C group, n=41) and study group (S group, n=41). After anesthesia induction, 2% lidocaine 0.5 mL or an equal volume of normal saline was injected into Meckel’s cave. HR and MAP were recorded at seven time-points, and the TCR incidence was compared.Results: HR decreased in the C group at the time of foramen ovale puncture (T5) and at the time of ganglion compression (T6) compared with that at the moment of needle puncture (T4) (P< 0.05), but almost no change in the S group. HR was lower in the C group compared with the S group at T5 and T6 (P< 0.05). MAP increased significantly at T5 and T6 compared with that at T4 in the C group (P< 0.05), but almost no increase in the S group. Compared with the C group, MAP was lower at T5 and T6 in the S group (P< 0.05). There were no significant differences in HR and MAP between the two groups at T1, T2, T3, T4 and T7. The incidence of bradycardia was higher in the C group than that in the S group (P< 0.05).Conclusion: Trigeminal ganglion block was an effective approach to prevent TCR in elderly patients during PBC.Keywords: trigeminal neuralgia, trigeminocardiac reflex, trigeminal ganglion block, elderly patients
