Journal of Pain Research (Oct 2021)
Ultrasound-Guided Selective Pulsed Radiofrequency Treatment of Great Auricular Nerve for Post-Herpetic Neuralgia of the Head and Neck: A Case Report
Abstract
Hong-Su Zhou,1 Ting-Ting Li,2 Yu Pi,3 Song Wen,4 Ting-Hua Wang,1 Liu-Lin Xiong1 1Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China; 2Editorial Department of Ibrain Journal, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of China; 3National Traditional Chinese Medicine Clinical Research Base and Western Medicine Translational Medicine Research Center, South West Medical University, Luzhou, 646000, People’s Republic of China; 4Pain Management, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, People’s Republic of ChinaCorrespondence: Liu-Lin XiongDepartment of Anesthesiology, Affiliated Hospital of Zunyi Medical University, No. 201. Da Lian Road, Hui Chuan District, Zunyi, Guizhou, 563000, People’s Republic of ChinaEmail [email protected] WangDepartment of Anesthesiology, Affiliated Hospital of Zunyi Medical University, No. 201. Da Lian Road, Hui Chuan District, Zunyi, Guizhou, 563000, People’s Republic of ChinaEmail [email protected]: The current study aimed to further verify the feasibility of ultrasound-guided selective pulsed radiofrequency (PRF) therapy of greater auricular nerve (GAN) in the treatment of head and neck post-herpetic neuralgia (PHN) by observing the efficacy and safety.Methods: Under the guidance of high-frequency ultrasound (Frequency: 10 MHz), the GAN was identified by a radiofrequency electrode trocar with a transverse in-plane approach, which was inserted into the GAN, then the inner needle of the trocar was retracted. After adjusting the technical variables (electrode tip temperature: 42°C, output voltage: 60 V, pulse frequency: 2 Hz, pulse width: 22 ms, single duration: 240 s, two times), the radiofrequency electrode placed on the auricle and below the ear for sensory and motor tests began to work.Results: The pain in the left head and neck of the patient lasted for more than 1 month, we decided to try selective PRF of GAN guided by ultrasound for the first time. Immediately after the treatment, 11-point pain intensity numerical rating scale (PI-NRS) score ranged from 5 to 1. During his hospitalization, mecobalamine and gabapentin were taken instead of opioids. Seven days after the procedure, PI-NRS score was 2, the degree of numbness the patient he felt by himself in the original lesion area relieved from 100% to 40%, the depression module of the Patient Health Questionnaire-9 (PHQ-9) score was from 7 to 5, the Generalized Anxiety Disorder-7 (GAD-7) score from 8 to 4, the range of pain areas was reduced to external auditory tract, and there were no adverse events occurring.Conclusion: The ultrasound-guided selective PRF treatment of GAN was safe and effective in the improvement of PHN in the head and neck, which is worthy of clinical promotion.Keywords: post-herpetic neuralgia, great auricular nerve, pulsed radiofrequency