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BJA Advance Access originally published online on August 1, 2006
British Journal of Anaesthesia 2006 97(4):559-563; doi:10.1093/bja/ael180
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Intranasal lidocaine 8% spray for second-division trigeminal neuralgia

A. Kanai*, A. Suzuki, M. Kobayashi and S. Hoka

Department of Anesthesiology, Kitasato University School of Medicine 1-15-1 Kitasato, Sagamihara 228-8555, Japan

*Corresponding author. E-mail: kanaiakifumi{at}aol.com

Background. Trigeminal nerve block has been widely used for trigeminal neuralgia. This may induce paraesthesia. The second division of the trigeminal nerve passes through the sphenopalatine ganglion, which is located posterior to the middle turbinate and is covered by a mucous membrane. We examined the effectiveness of intranasal lidocaine 8% spray on paroxysmal pain in second-division trigeminal neuralgia.

Methods. Twenty-five patients with second-division trigeminal neuralgia were randomized to receive two sprays (0.2 ml) of either lidocaine 8% or saline placebo in the affected nostril using a metered-dose spray. After a 7 day period, patients were crossed over to receive the alternative treatment. The paroxysmal pain triggered by touching or moving face was assessed with a 10 cm visual analogue scale (VAS) before and 15 min after treatment. Patients used a descriptive scale to grade pain outcome, and were asked to note whether the pain returned and how long after therapy it recurred.

Results. Intranasal lidocaine 8% spray significantly decreased VAS [baseline: 8.0 (2.0) cm, 15 min postspray: 1.5 (1.9) cm, mean (SD)], whereas the placebo spray did not [7.9 (2.0) cm, 7.6 (2.0) cm]. Moreover, pain was described as moderate or better by 23 patients of the lidocaine spray and 1 of the placebo group. The effect of treatment persisted for 4.3 h (range 0.5–24 h).

Conclusions. Intranasal lidocaine 8% administered by a metered-dose spray produced prompt but temporary analgesia without serious adverse reactions in patients with second-division trigeminal neuralgia.


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Home page
 Br J AnaesthHome page
D. W. Wheeler and A. Kanai
Lidocaine intranasal spray for treatment of trigeminal neuralgia
Br. J. Anaesth., February 1, 2007; 98(2): 275 - 276.
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Stinging and burning after intranasal lidocaine
Daniel W Wheeler
British Journal of Anaesthesia, 19 Oct 2006 [Full text]
Response to the E-letter
Akifumi Kanai
British Journal of Anaesthesia, 10 Nov 2006 [Full text]

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