J Anesth Perioper Med. 2018;5(6):355-358. https://doi.org/10.24015/ebcmed.japm.2018.0053
From the Department of Anesthesiology and Pain Management, University of Rochester, Rochester, NY, USA.
Correspondence to Dr. Nobuyuki-Hai T. Tran at email@example.com.
EBCMED ID: ebcmed.japm.2018.0053 DOI: 10.24015/ebcmed.japm.2018.0053
The treatment of neuropathic pain of all sources can be particularly daunting. This is especially true when this type of pain arises unpredictably in an otherwise “routine” setting. In this work, we discuss a case in which a 72-year-old man with multiple medical problems (among them are coronary artery disease, hypertension, a basilar artery cerebral aneurysm, and multiple cancerous thyroid nodules) who underwent an otherwise uneventful right thyroidectomy. Following this procedure, he developed intractable trigeminal neuralgia believed to be the result of vertebrobasilar dolichoectasia. The neuralgia proved to be refractory to the standard pharmacologic treatments which included carbamazepine, opiates, and gabapentenoids. With both the explicit written and verbal consent of this patient, we discuss his case as well as possible pathogenic mechanisms that may have come into play with special attention to post-operative vascular changes. In addition, the use of lidocaine and one of its less well known neuropharmacological mechanisms of action is examined as one explanation of its effectiveness in this setting.
Declaration of Interests
The authors declare no conflicts of interest.
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