LOCAL ANESTHETIC SPREAD TO THE CONTRALATERAL TRIGEMINAL GANGLION

Kim T. Nguyen
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Abstract

Chronic neuropathic pain syndromes can severely affect a person’s quality of life. Trigeminal neuralgia is among these syndromes and involves the mandibular branch of the fifth cranial trigeminal nerve. Patients typically present with facial pain described as electrical and shock-like in nature, exacerbated by movements of the jaw such as talking and chewing. Many patients are unable to achieve adequate relief with medical management and therefore require interventions such as injections of local anesthetics, steroids, or glycerol. One method of injection uses ultrasound guidance for local anesthetic injection in the pterygopalatine fossa affecting the trigeminal ganglion. A 64-year-old woman with a history of trigeminal neuralgia presented for a trigeminal nerve block on her right side via ultrasound guidance. Following the injection, she experienced the desired effect of numbness on her right side in the distribution of the trigeminal nerve. In addition, the patient reported feeling the same effects on her left side despite no injection being done on that side. We describe a unique case in which local anesthetics spread through the pterygopalatine fossa and across the midline, affecting the contralateral trigeminal ganglion. Patients should be monitored for hemodynamic changes following this injection. Key words: Trigeminal neuralgia, trigeminal nerve block, pterygopalatine fossa, regional block, trigeminal ganglion
局部麻醉扩散到对侧三叉神经节
慢性神经性疼痛综合征会严重影响一个人的生活质量。三叉神经痛是这些综合征之一,累及第五颅三叉神经下颌支。患者通常表现为面部疼痛,被描述为电和电击样的疼痛,并因下颌运动(如说话和咀嚼)而加剧。许多患者无法通过医疗管理获得充分的缓解,因此需要注射局部麻醉剂、类固醇或甘油等干预措施。其中一种注射方法是在影响三叉神经节的翼腭窝采用超声引导进行局麻药注射。64岁女性,有三叉神经痛病史,经超声引导右侧三叉神经阻滞。注射后,患者在右侧三叉神经分布处出现了预期的麻木效果。此外,患者报告说,尽管左侧没有注射,但左侧也有同样的效果。我们描述了一个独特的情况下,局部麻醉药通过翼腭窝和中线扩散,影响对侧三叉神经节。注射后应监测患者的血流动力学变化。关键词:三叉神经痛,三叉神经阻滞,翼腭窝,区域阻滞,三叉神经节
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