Abstract :
Introduction: Trigeminal neuralgia (tn) is characterized by a recurrent, unilateral sharp pain in the
distribution of branches of the trigeminal nerve. The prevalence of this condition is about 1 in 25000 people.
It responds poorly to traditional analgesics; antiepileptic drugs are effective. Palliation of pain, restoration
of therapeutic sleep, maintenance of function, and improvement in quality of life remain the mainstays of
treatment. Magnesium could be expected to modulate neuropathic pain by blocking the NMDA receptor
calcium ionophore. Intravenous lignocaine blocks neuropathic pain by action on sodium channel and
blockade of central hypersensitivity.We want to report a series of 12 cases of resistant trigeminal neuralgia
treated by intravenous magnesium sulphate and lignocaine.
Materials and Methods: Patients having history of recurrence to the treatment of trigeminal neuralgia
in spite of treatment either by antiepileptics or neurolytic block were included in our study. In all patients
detail preoperative evaluation and investigations were done. After intravenous catheter, patients received
inj. magnesium sulphate 30mg/kg as an infusion in 500 ml of ringer lactate solution over a period of 1 hour
followed by inj. lignocaine 2mg/kg in 500 ml of DNS once in a week for consecutive 3 weeks. During
the infusion patients were monitored with continuous ECG, pulse oximetry and NIBP. Patients were asked
to note the severity of pain measured on visual analogue scale (vas) from 0 to 10 (0 as no pain and 10 as
severe pain). Also patients were asked to note the total dose of medications he or she already taking for
pain relief, improvement in quality of pain and duration after which pain recurred.
Observation: Good pain control was observed in three patients up to nine months and were managed by
tab carbamazepine 150 mg once a day after recurrence. Seven patients got recurrence after six months and
were managed by tab carbamazepine and tab gabapentine. Recurrences of pain occurred after four months
in two patients and were managed by inj. absolute alcohol for neurosis as no effective pain control after
antiepileptic.
Conclusion: We had observed good pain control more than four months with improved quality of life.
Antiepileptic drug dose requirement after recurrence of pain was less as compared to prior to magnesium
sulphate and lignocaine therapy in all patients.
Keyword :
Trigeminal neuralgia, Magnesium sulphate, Lignocaine.