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Pain relief can be painful
Ashish Bindra1, Parmod Bithal1, Navdeep Sokhal1
1Department of Neuroanesthesiology, All Institute of Medical Sciences, New Delhi, India.
Indian Journal of Palliative Care
|November 25, 2015
Summary
Mandibular nerve blocks for trigeminal neuralgia can cause temporomandibular joint (TMJ) dislocation in elderly patients. Careful clinical evaluation is crucial before pain procedures in geriatric populations.
Area of Science:
- Neurology
- Pain Management
- Geriatric Medicine
Background:
- Mandibular nerve block is a common outpatient procedure for trigeminal neuralgia.
- Trigeminal neuralgia involves severe facial pain in the trigeminal nerve distribution.
Observation:
- An elderly, edentulous patient developed recurrent temporomandibular joint (TMJ) dislocation after a mandibular nerve block.
- The patient experienced severe pain and inability to close their mouth.
Findings:
- Initial closed reduction of the TMJ provided temporary relief but failed due to recurrent dislocation.
- Management involved Barton dressing and autologous blood injection into the TMJ.
Implications:
- This case highlights the risk of TMJ dislocation following mandibular nerve blocks, especially in the elderly.
- Emphasizes the need for thorough clinical assessment and cautious pain management in geriatric patients.
- Suggests considering pre-existing conditions and anatomical factors in elderly patients undergoing nerve blocks.
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