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Transient facial palsy in sphenoidal electrode placement
J Iriarte1, J Parra, A M Kanner
1Rush Epilepsy Center, Chicago, Illinois, USA.
Epilepsia
|December 1, 1996
Summary
Local anesthesia for sphenoidal electrode (SE) insertion is linked to transient facial palsy, a complication not seen with fentanyl. Patients undergoing SE placement should be informed about this potential risk.
Area of Science:
- Neurology
- Neurosurgery
- Anesthesiology
Background:
- Sphenoidal electrode (SE) insertion for epilepsy monitoring can cause pain, managed with local anesthesia (lidocaine) or intravenous fentanyl.
- Transient facial palsies have been reported post-SE insertion, but their incidence and characteristics are not well-defined.
Purpose of the Study:
- To investigate the hypothesis that local anesthesia affects the seventh cranial nerve, leading to facial palsy during SE insertion.
- To compare the incidence and characteristics of facial palsy in patients undergoing SE insertion with local anesthesia versus intravenous fentanyl.
Main Methods:
- A retrospective study comparing two groups of 25 patients each undergoing prolonged video-EEG (VEEG) monitoring with SE.
- Group A received 1% lidocaine infiltration at the SE insertion site; Group B received intravenous fentanyl (100-200 micrograms).
- Blood pressure was monitored throughout the procedures.
Main Results:
- 20% of patients (5/25) in the lidocaine group (Group A) experienced transient facial palsy (4 complete, 1 partial, 1 bilateral).
- Facial palsy in Group A lasted 1-7 minutes (mean 3.2 min) with complete recovery.
- No facial palsy complications were observed in the fentanyl group (Group B) (p = 0.025).
Conclusions:
- Transient facial palsy is a notable complication associated with SE insertion using local anesthesia.
- Patients undergoing SE placement with local anesthesia should be counseled regarding the risk of temporary facial nerve dysfunction.