Lidocaine infusion for the treatment of intractable trigeminal neuralgia: retrospective case series and systematic review

Abstract

Background: Trigeminal neuralgia classically manifests with intense facial pain. When the condition is unresponsive to standard treatment, it is referred to as refractory trigeminal neuralgia. Aims and objectives: The study aimed to investigate the effectiveness, duration of pain relief and safety profile of intravenous Lidocaine in managing this debilitating condition. Materials and methods: A retrospective case series in a UK tertiary neurosurgery centre studied twenty trigeminal neuralgia patients who underwent Lidocaine infusion from January 2016 to December 2022. A systematic review of the literature was also undertaken. Results: After the first intravenous Lidocaine injection, 16 patients (80%) achieved an efficacy score of III, i.e. they reported pain that had become adequately controlled with their medications. In addition, one patient achieved a BNI score of II and three patients (15%) did not respond to treatment. In addition, nine patients (45%) reported reduced pain intensity for more than six months, six patients (30%) for less than three months, and five patients (25%) for three to six months. There were no treatment-related significant adverse events. Conclusion: Lidocaine infusion therapy for refractory worsening trigeminal neuralgia is safe and improved pain control when combined with ongoing medical therapy.