Intravenous lidocaine and magnesium on responses of A-δ and A-β nerve fibers at non-affected and affected areas in three cases of neuralgias Lidocaine and magnesium for neuralgias

Main Article Content

Young-Chang P. Arai, MD Makoto Nishihara, MD Tatsunori Ikemoto, MD Hironori Saisu, DDS Keiko Owari, MD

Abstract

Intravenous magnesium and lidocaine have been used for the management of intractable pain individually or in combination. A study reported on the positive effects when used in combination on neuralgia when antiepileptic drugs failed, but nobody has clarified how the combination works. The aim of the present case report is to see how a combination of intravenous magnesium and lidocaine influenced electrically-evoked responses of peripheral A-δ and A-β nerve fibers at non-affected and affected areas in three patients with neuralgia. For nociceptive stimulation, a method of intraepidermal electrical stimulation (IES) was used for the selective activation of cutaneous A-δ fibers, using a stainless steel concentric bipolar needle electrode. For tactile stimulation, similar cutaneous sites were stimulated for cutaneous A-β fibers using the same electrode. Three patients with intractable trigeminal neuralgia or intercostal neuralgia were treated using an intravenous infusion of a combination of 1.2g of magnesium and 100mg of lidocaine for one hour. Although all patients experienced sound pain relief after the combined intravenous infusion therapy, the combination had a different effect on electrically-evoked responses of peripheral A-δ and A-β nerve fibers at non-affected and affected areas in each patient.

Article Details

How to Cite
ARAI, Young-Chang P. et al. Intravenous lidocaine and magnesium on responses of A-δ and A-β nerve fibers at non-affected and affected areas in three cases of neuralgias. Medical Research Archives, [S.l.], v. 9, n. 5, may 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2412>. Date accessed: 28 oct. 2021. doi: https://doi.org/10.18103/mra.v9i5.2412.
Section
Research Articles

References

1. Gadient PM1, Smith JH. The neuralgias: diagnosis and management. Curr Neurol Neurosci Rep. 2014;14:459. doi: 10.1007/s11910-014-0459-3.
2. Williams EH, Williams CG, Rosson GD, Heitmiller RF, Dellon AL. Neurectomy for treatment of intercostal neuralgia. Ann Thorac Surg. 2008;85:1766-70. doi: 10.1016/j.
3. Obermann M. Treatment options in trigeminal neuralgia. Ther Adv Neurol Disord. 2010;3:107-15.
4. Prisco L, Ganau M, Bigotto F, Zornada F. Trigeminal neuralgia: successful antiepileptic drug combination therapy in three refractory cases. Drug Healthc Patient Saf. 2011;3:43-5.
5. Pollock BE. Surgical management of medically refractory trigeminal neuralgia. Curr Neurol Neurosci Rep. 2012;12:125-31.
6. Huang CF, Chuang JC, Tu HT, Chou MC. Microsurgical outcomes after failed repeated Gamma Knife surgery for refractory trigeminal neuralgia. J Neurosurg. 2006;105 Suppl:117-9.
7. Cahana A, Carota A, Montadon ML, Annoni JM. The long-term effect of repeated intravenous lidocaine on central pain and possible correlation in positron emission tomography measurements. Anesth Analg. 2004;98:1581-4.
8. Schwartzman RJ, Patel M, Grothusen JR, Alexander GM. Efficacy of 5-day continuous lidocaine infusion for the treatment of refractory complex regional pain syndrome. Pain Med. 2009;10:401-12.
9. Brill S, Sedgwick PM, Hamann W, Di Vadi PP. Efficacy of intravenous magnesium in neuropathic pain. Br J Anaesth. 2002;89:711-4.
10. Turan A, Memiş D, Karamanlioğlu B, Güler T, Pamukçu Z. Intravenous regional anesthesia using lidocaine and magnesium. Anesth Analg. 2005;100:1189-92.
11. Arai YC, Hatakeyama N, Nishihara M, Ikeuchi M, Kurisuno M, Ikemoto T. Intravenous lidocaine and magnesium for management of intractable trigeminal neuralgia: a case series of nine patients. J Anesth. 2013 Dec;27(6):960-2. doi: 10.1007/s00540-
12. Otsuru N, Inui K, Yamashiro K, Miyazaki T, Takeshima Y, Kakigi R. Assessing Aδ fiber function with lidocaine using intraepidermal electrical stimulation. J Pain. 2010 Jul;11(7):621-7. doi: 10.1016/j.jpain.2009.10.001.
13. Abdi S, Lee DH, Chung JM. The anti-allodynic effects of amitriptyline, gabapentin, and lidocaine in a rat model of neuropathic pain. Anesth Analg. 1998;87:1360-6.
14. Lauretti GR. Mechanisms of analgesia of intravenous lidocaine. Rev Bras Anestesiol. 2008;58:280-6.
15. McCleane G. Intravenous lidocaine: an outdated or underutilized treatment for pain? J Palliat Med. 2007;10:798-805.
16. Mony L, Kew JN, Gunthorpe MJ, Paoletti P. Allosteric modulators of NR2B-containing NMDA receptors: molecular mechanisms and therapeutic potential. Br J Pharmacol. 2009; 157:1301-17.
17. Collins S, Zuurmond WW, de Lange JJ, van Hilten BJ, Perez RS. Intravenous magnesium for complex regional pain syndrome type 1 (CRPS 1) patients: a pilot study. Pain Med. 2009;10:930-40.
18. Brandon Alan Van Noord, Jack Berger and Arash Motamed. Opioid Resistant Pain Successfully Managed with Magnesium, Lidocaine and Ketorolac in the Post-Anesthesia Care Unit: A Case Series. J Anesthe Clinic Res 2012, 3:196.