Khatun et al., J Pain Relief 2013, S3 DOI: 10.4172/2167-0846.S3-002 Research Article Open Access J Pain Relief ISSN: 2167-0846 JPAR, an open access journal New Nonpharmacological Treatment of Neuropathic Pain A Clinical Study of Trigeminal Neuralgia with Incredible Pain, Satisfaction with Quality Pain Management Shohda Khatun 1 *, Mozammal Hossain 2 , Rajan Karmakar 3 , M Assaduzzaman 4 and Al Mamoon Ferdousi 5 1 Senior Consultant, Faculty of Dentistry, Department of Oral & Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh 2 Assistant Professor, Faculty of Dentistry, Department of Conservative Dentistry & Endodontics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh 3 Assistant Professor, Oral and Maxillofacial Surgery, Bangladesh Dental College, Dhaka, Bangladesh 4 Research Assistant, Faculty of Dentistry, Department of Oral & Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh 5 Faculty of Dentistry, Formerly Professor of Oral and Maxillofacial Surgery, Bangabandhu Sheikh mujib Medical University, Dhaka, Bangladesh Abstract This is a prospective analytical study of 164 trigeminal neuralgic pain patients. The study was undertaken in order to determine whether bupivacaine hydrochloride prevent TN pain and reduce the relapse of trigeminal neuralgic pain. The patient was selected who were previously received alcohol block, Carbamazepine, Cryosurgery, or Peripheral Neurectomy in different clinics, after relapse in 6-8 months with same intensity of pain. Those patients were referred to department of oral and maxillofacial surgery, Bangabandu Sheikh Mujib medical university Shahabag Dhaka Bangladesh between the years 2008-2010 were included in this study. The affected nerve was blocked with 1.5 ml to 10 ml of 0.5% bupivacaine HCl according to severity of pain. Patient’s visual analogue scores (VAS) Verbal rating scale (VRS) were recorded on 1st day 3rd day, 7th day, 15th day. There was a signifcant difference between 1st day medicament and 15th day medicament of value VAS. 1st day value was 83.10 ± 6.06, at 3rd days was 39.60 ± 7.86, at 7 th days was 16.25 ± 6.46 and at 15 th days was 3.30 ± 3.19. It can be concluded that administration of 0.5% bupivacaine HCl nerve block at regular interval in different dose can be considered as alternative method to prevent TN pain and frequent relapse in treatment of Trigeminal neuralgia. *Corresponding author: Shohda Khatun, Senior Consultant, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, E-mail: nazmus_sakib70@yahoo.com Received April 20, 2013; Accepted May 27, 2013; Published May 29, 2013 Citation: Khatun S, Hossain M, Karmakar R, Assaduzzaman M, Ferdousi AM (2013) A Clinical Study of Trigeminal Neuralgia with Incredible Pain, Satisfaction with Quality Pain Management. J Pain Relief S3: 002. doi:10.4172/2167-0846.S3- 002 Copyright: © 2013 Khatun S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Trigeminal neuralgia; Bupivacaine; Visual analogue score; Verbal rating score Introduction Trigeminal neuralgia (TN) is a disease characterized by paroxysmal and refractory severe pain occurring along the trigeminal nerve. Te pain is strictly limited to the distribution of the ffh cranial nerve and can involve one, two or even three branches. Bilateral cases are very rare [1]. Te management of trigeminal neuralgia continues to be a major therapeutic challenge. Current treatments are mainly divided into medical treatments and surgery and medication is ofen the frst- line treatment. Traditionally, patients are ofered surgical options only when medications fail or severe side efects develop [2]. Although current treatment is initially medical, medical treatment fails in 30% of cases because of inadequate pain control or side efects of the drugs used [3]. Surgery can alleviate the pain, but is associated with morbidity and mortality and is not always efective [4]. Phenytoin, carbamazepine, clonazepam, gabapentin, and baclofen have also been used as anti neuralgic drugs [5,6]. Medical management with anticonvulsant (antiepileptic) drugs has debilitating side efects and the drugs eventually lose efectiveness [7]. Te medical treatments (anticonvulsant medications) eliminate or signifcantly reduce the pain in approximately 75% of patients and are considered the treatment of choice for incident cases of TN [8]. Unfortunately, the relief provided by medical therapy generally decreases over time. When medications fail to relieve TN pain attacks, it is important to reduce the risk of severe side efects of surgery and surgical squeals seen in cranial surgery considering the mean age of TN patients. Nerve block with local anesthetics is appropriate in such cases because this treatment is reversible and non traumatic and can be efectively used. In this study nerve block with a 0.5% Bupivacaine hydrochloride for treating TN as a minor intervention to decrease the risk of intracranial neurosurgical complications, eliminate the disadvantages of carbamazepine or on whom carbamazepine is no longer efective or relapse from diferent moralities of treatment. 0.5% Bupivacaine hydrochloride presenting a solution for patients sufering from such a difcult situation. Materials and Methods Subjects A total of 164 patients (Male: 62, Female: 102, age: ranged from 55 to 70 years), who were attended Oral & Maxillofacial Department, Faculty of Dentistry, Bangabandhu Sheikh Mujib Medical University Bangladesh were included for this study. Among the 164 patients, 30 patients received alcohol, 25 patients received cryosurgery, 102 patients were treated with Carbamazepine, and 7 patients treated with peripheral neurectomy. Te patients were divided into 4 study group according to their nerve involvement: Group I: (n=70): Inferior alveolar nerve Group II: (n=30): Inferior alveolar nerve, anterior/middle/posterior superior alveolar nerve Group III: (n=55): Infra orbital nerve/zygomatico facial nerve, anterior/middle/posterior superior alveolar nerve. Group IV: (n=6): Infra orbital nerve / zygomatico facial nerve, zygomatico temporal anterior/middle/posterior superior alveolar nerve Journal of Pain & Relief J o u r n a l o f P a i n & R e l i e f ISSN: 2167-0846