Lidocaine Infusion for Refractory Trigeminal Neuralgia: Retrospective Series & Review

Overview

This study evaluates intravenous lidocaine as a rescue therapy for refractory trigeminal neuralgia (TGN) in 20 patients, demonstrating notable pain relief with a favorable safety profile. A systematic review supports lidocaine infusion as a promising option for patients unresponsive to conventional treatments.

Background

Trigeminal neuralgia (TGN) is a severe facial pain disorder characterized by brief, intense paroxysms in the trigeminal nerve distribution. Classical TGN is often due to neurovascular compression, while secondary forms arise from identifiable pathologies. Standard treatment includes carbamazepine, but 6–27% of patients remain refractory, necessitating alternative approaches such as surgery or intravenous lidocaine infusion. Lidocaine offers a potential non-surgical option, especially for patients unsuitable for invasive procedures.

Data Highlights

Key Findings

• Intravenous lidocaine infusion provided symptomatic relief in medically refractory TGN patients who failed standard pharmacological treatments.
• The Barrow Neurological Institute (BNI) pain intensity score was used to assess treatment efficacy, showing improvement post-infusion.
• Duration of analgesic effect varied, with some patients experiencing relief lasting beyond six months.
• The infusion protocol of 1.5 mg/kg over 60 minutes was well tolerated with continuous vital monitoring ensuring safety.
• Systematic review of literature corroborated the potential benefit of lidocaine infusions in TGN, despite heterogeneity in study designs and outcome measures.

Clinical Implications

Intravenous lidocaine infusion represents a viable rescue therapy for patients with refractory trigeminal neuralgia who are unsuitable for or have failed surgical interventions. Clinicians should adhere to established dosing protocols and monitoring guidelines to maximize safety. This approach may extend pain relief duration and improve quality of life in difficult-to-treat cases.

Conclusion

Intravenous lidocaine infusion is a promising therapeutic option for refractory trigeminal neuralgia, offering effective pain relief with an acceptable safety profile. Further prospective studies are warranted to optimize protocols and confirm long-term benefits.

References

1. ICHD-3 Classification -- International Headache Society
2. Foo et al. 2020 -- Consensus on Intravenous Lidocaine Safety
3. Barrow Neurological Institute Pain Score -- BNI Pain Intensity Score
4. Leeds Teaching Hospitals NHS Trust Protocol -- Lidocaine Infusion 2016-2022