A simple infusion of lidocaine 100 mg and Magnesium sulphate 1.2 gm over 1 hour – weekly for 3 weeks, gave good results in 9 trigeminal neuralgia resistant cases.
J Anesth. 2013 May 28. [Epub ahead of print]
Intravenous lidocaine and magnesium for management of intractable trigeminal neuralgia: a case series of nine patients.
Arai YC, Hatakeyama N, Nishihara M, Ikeuchi M, Kurisuno M, Ikemoto T.
http://www.ncbi.nlm.nih.gov/pubmed/23712613
- Intractable cases age 41-72
- already on Carbamazepine, gabapentin, pregabalin, mirtazepine, and/or imipramine.
- gave 100 mg lidocaine and magnesium sulphate 1.2 gm given over 60 minutes – didn’t say in how much solution but I imagine anything under 500 mls run in over 1 hour would do. I used to use it (100 mg lidocaine and 2 gm mag sulphate) in a 20 ml syringe by syringe pump with saline – but at that concentration could burn initially and be hard on veins.
- I suspect any concentration of that material could be hard on veins and when I give IV lidocaine or Magnesium I start the IV in the leg so it doesn’t matter so much
- 2 cases had short lived dizziness – this is not really that much IV so suspect easily tolerated.
- One warning – both lidocaine and Magnesium could potentially increase heart block temporarily in subjects with this issue – might want to run an ECG beforehand on older subjects.
Comment – this emphatically shows how “one shot wonders” should never be required or anticipated – there was not much difference after the first shot but progress thereafter. It just slays me when articles are published about one cortisone shot or one IV not working – I feel like asking “were you born yesterday?”.
Half these people were in severe pain – yet rescued – people should always consider – there will be new treatments all the time – never give up hope.