Lidocaine infusion for the treatment of intractable trigeminal neuralgia: retrospective case series and systematic review.
Trigeminal neuralgia classically manifests with intense facial pain. When the condition is unresponsive to standard treatment, it is referred to as refractory trigeminal neuralgia. The study aimed to investigate the effectiveness, duration of pain relief and safety profile of intravenous Lidocaine in managing this debilitating condition. 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. 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. Lidocaine infusion therapy for refractory worsening trigeminal neuralgia is safe and improved pain control when combined with ongoing medical therapy.