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Ef Cacy of Intravenous Lidocaine and Magnesium in Intractable Trigeminal Neuralgia: A Preliminary Report
Ef Cacy of Intravenous Lidocaine and Magnesium in Intractable Trigeminal Neuralgia: A Preliminary Report
http://dx.doi.org/10.1016/j.jns.2016.09.017
0022-510X/© 2016 Elsevier B.V. All rights reserved.
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150 Letter to the Editor
Table 1
Demographics of the 7 patients that were treated with combination infusion after surgical intervention had failed to provide pain relief.
No. 1 2 3 4 5 6 7
from the channel pore allowing the flow of ions down their concentra- In spite of the positive results, this report has several limitations.
tion gradients. Although the presence of the magnesium ion impedes First, due to the low incidence of intractable TN and to an even lower in-
ion flow, it is not an antagonist in the strict sense of the definition. Per- cidence of intractable cases where MVD failed to provide relief, we were
haps higher concentrations of magnesium in the extracellular compart- not able to identify sufficient numbers of patients for conducting a ran-
ment impede the release of the magnesium ion from the channel pore domized, controlled trial. The consistent and encouraging response to
because the concentration gradient would be steeper. The therapeutic treatment that we observed in just these few subjects persuaded us to
use of magnesium, through both oral and intravenous routes of admin- present our early observations for justification and in anticipation of
istration, has been proven safe and effect for treating many conditions conducting a prospective, multicenter, randomized and placebo-con-
including chronic pain. Lidocaine acts on many pathways when it is ad- trolled trial. Second, we have not been able to determine the effect of in-
ministered intravenously. It increases cerebrospinal fluid acetylcholine fusing either magnesium or lidocaine alone, thus precluding us from
and causes blockade of central sensitization. Lidocaine affects both cen- establishing whether the drug combination produces an additive, an-
tral and peripherally located sodium channels and can thus directly tagonistic or synergistic effect. Nonetheless, these observations support
and/or indirectly modulate central sensitization [6]. These mechanisms the conclusion that the simultaneous intravenous infusion of magne-
account for the application of lidocaine in refractory pains including TN. sium and lidocaine warrants further investigation as a safe and effective
Our study is consistent with a previous report of analgesic efficacy option for managing difficult cases of TN, potentially reducing or pre-
following the intravenous infusion of lidocaine and magnesium. [7]. cluding the need for surgery and other invasive techniques.
The combination protocol provided encouraging results for patients
with intractable TN in this case report. The adverse effects associated Conflict of interest
with the treatment protocol in our study were limited to a single brief
episode of mild dizziness in 1 subject following infusion. Due to the dif- None declared.
ferent mechanisms, the combination of lidocaine and magnesium might
be predicted to have at least an additive effect thus providing a better References
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Letter to the Editor 151
Xun Zhu MM
Department of Neurosurgery, Northern Jiangsu People's Hospital, Yangzhou
225001, Jiangsu Province, China
E-mail address: zhuxun0702@163.com
Descargado para Anonymous User (n/a) en Pontifical Xavierian University de ClinicalKey.es por Elsevier en octubre 20, 2019.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2019. Elsevier Inc. Todos los derechos reservados.