射频热凝术前两种局部麻醉药行三叉神经阻滞对围手术期疼痛管理的效果研究

Evaluation of the analgesic effects of preoperative peripheral nerve block using two kinds of local anaesthetics in patients with trigeminal neuralgia undergoing radiofrequency thermocoagulation of gasserian ganglion

目的:前瞻性评估射频术前2种药物行三叉神经阻滞对围手术期及术中穿刺镇痛的效果。方法:选择原发性三叉神经痛第3支患者90例,拟接受半月神经节射频热凝术(RFT),随机分为3组:空白对照组N组(n=30),不进行神经阻滞;A组(n=30)术前2 d予以2%盐酸利多卡因2 ml行下牙槽神经阻滞,B组(n=30)术前2 d予以复方盐酸利多卡因2 ml行下牙槽神经阻滞。用VAS评分法记录评价给药前、给药后24、48 h以及射频穿刺时的疼觉强度。结果:与对照组相比,A组和B组24 h后平均疼痛以及最强疼痛值显著减轻(P<0.01),同时改善睡眠质量(P<0.01),并增加了镇痛的满意度(P<0.05)。48h后B组疼痛缓解及睡眠质量改善明显高于A组(P<0.05)。此外,A、B组患者行射频治疗穿刺过程中神经疼痛发作强度较对照组明显减弱(P<0.05),B组效果优于A组(P<0.05)。结论:长效麻醉药复方盐酸利多卡因行外周神经阻滞是缓解三叉神经痛患者射频热凝术前和术中穿刺疼痛的有效途径。

Objective： To evaluate the analgesic effects of two kinds of preoperative peripheral nerve block drug in patients with trigeminal neuralgia undergoing radiofrequency thermocoagulation（ RFT） of gasserian ganglion. Methods： 90 patients with classic trigeminal neuralgia of the 3rd branch were scheduled to undergo RFT of the gasserian ganglion and were randomly divided into 3 groups（ n =30）. The patients in group N without nerve block were served as the controls. The patients in group A and B were treated by the nerve block of inferior alveloar with 2 ml of 2% lidocaine hydrochloride and 2 ml of compound lidocaine hydrochloride for each respectively 2d before RFT. The pain control was studied by VAS method before and 24,48 h after nerve blocking and during pucture for RFT. Results： Compared with the control group,24 h after nerve blocking,the average pain and the most pain VAS value of group A and B were significantly reduced（ P〈0. 01）; sleep quality and analgesia satisfaction were improved in group A and B（ P〈0. 05）. 48 h after nerve blocking the pain relief and sleep quality improvement of group B were more than those of group A（ P〈0. 05）. In addition,during RFT puncture the pain intensity of group A and B were less than that of group N（ P〈0. 05）. The pain control in group B was more effective than that in group A. Conclusion： A single peripheral nerve block with long-term narcotic compound lidocaine hydrochloride can be an effective way to relieve preoperative and operative pain for RFT of trigeminal neuralgia.