Application of a mandibular nerve block using an indwelling catheter for intractable cancer pain

Abstract

We report a case in which a mandibular nerve block using an indwelling catheter was employed for pain management in a terminal case of orofacial cancer. The patient was a 74-year-old female weighing 27 kg. She had a 27-month history of mouth floor and tongue cancer. The cancer recurred and spread to bilateral face and neck. The severest pain mainly originated from the right mandibular region. Two steps of pain relief were performed for the patient. First, pain control using 1% lidocaine or 0.25% bupivacaine administered intermittently or continuously through an indwelling catheter in the mandibular nerve was performed for 1 week to estimate the amount of pain relief thereby obtained. Second, a neurolytic block was applied to the mandibular nerve through the catheter. After the neurolytic block, the total dosage of morphine and diclofenac remained unchanged for 2 months. We conclude from the present case that this technique is an excellent means of obtaining long-term pain control in patients with intractable orofacial cancer pain.

Pain management of a mandibular fracture in an alpaca (Vicugna pacos) via epidural catheter placement in the mandibular foramen

“…In human medicine, the use of indwelling catheters for continuous block of the mandibular nerve in a patient with intractable orofacial cancer pain, trigeminal neuralgia or mandibular fractures has been described 24–26. A neurolytic block was also utilised in one of the aforementioned cases after the block with local anaesthetic—an option that could be considered more appropriate in cases related to cancer pain 27.…”

Trigeminal Neuralgia in Pregnancy: A Management Challenge

“…Several case reports suggest use of a mandibular nerve block to control pain in patients suffering from TN, orofacial cancer, and fractured mandibles. [25][26][27] Traditionally it is done by eliciting paresthesia, but nerve stimulation can be used to target jaw jerk as the end point, which not only improves accuracy, but also possibly reduces the risk for intravascular or intraneural placement. 28 However, peripheral nerve blocks like mandibular nerve blocks are found to be less effective than central ganglion level procedures.…”

Effect of mandibular nerve block on postoperative analgesia in patients undergoing oropharyngeal carcinoma surgery under general anaesthesia

“…Using the lateral extra-oral approach, several authors obtained longterm pain control without any side-effects in patients with fractured mandible, 10 trigeminal neuralgia, 9 or intractable cancer-related pain. 11 The feasibility and benefit of continuous MNB should be evaluated after oropharyngeal surgery.…”

“…7 8 Several case reports suggest a role for continuous MNB for pain control in patients suffering from trigeminal neuralgia, 9 fracture of the mandible, 10 or terminal orofacial cancer. 11 To date, no published study has evaluated the value of MNB for control of postoperative pain after oropharyngeal cancer surgery. The aim of this prospective, double-blind, placebo-controlled study was to demonstrate that the MNB performed before GA for oropharyngeal cancer surgery improves postoperative analgesia.…”