Evaluation of Ultrasound guided Glossopharyngeal Nerve Block Technique

Title: Evaluation of Ultrasound Guided Glossopharyngeal Nerve Block Technique Glossopharyngeal

neuralgia, also known as vagal glossopharyngeal neuralgia, is characterized by intermittent episodes

of shooting sharp pain in the jaw, throat, tongue, and ear that fall within the sensory distribution of

the glossopharyngeal nerve (cranial nerve IX) Inclusion criteria: Patients (more than 18 years of age)

diagnosed with primary glossopharyngeal neuralgia not responding to medical management will be

included in the present study. Exclusion criteria: 1. Patients with cardiopulmonary diseases such as

myocardial infarction, and heart failure 2. Patients with mental disorders, local infection, or

pregnancy 3. Patients with abnormal coagulation function 4. Patients with history of snoring.

POSITION- Patient lying in the lateral position with a thin pillow under the head. Area between

mastoid process and angle of mandible will be scanned with high-frequency (13-6 MHz) linear array

hockey stick probe to locate styloid process. Colour flow dopler will be used to identify the internal

carotid artery and the internal jugular vein. A needle will be directed in an in plane approach

towards the styloid process; which will be hit and the needle slid posteriorly and 2 ml 1% lidocaine +

4 mg dexamethasone injected.Positive response - > 50% reduction NRS scores for at least 2 hours

following injection; patients having a positive response will be followed for 6 months.A combination

of acetaminophen (325mg) and tramadol (37.5mg) will be prescribed for 5 days post-procedure and

patient advised to take the same if NRS will be >3 and on SOS basis during follow up. Repeat block

will be performed if severity of pain increased to NRS of > 5 or pain relief decreased to less than

50%. PRIMARY Severity of pain on the basis of NRS Score SECONDARY Percentage pain relief

Reduction of analgesic usage, and psychological assessment of patient by using DSM-IV scale All

these assessments will be done before the procedure (baseline), 2 hours after the procedure, 2

weeks, 1, 3- and 6-months post-procedure; the patient assessment between 2 weeks to 6 months of

follow up will be done by telephonic communication SAMPLE SIZE- Using Wilcoxon signed rank test

(matched pair) for one tail (as score will reduce) and effect size 1, 15 cases are required.

Considering design effect (1.5) and 10% lost to follow up final sample size will be 25. STATYSTICAL

ANALYSIS- Paired t-test will be used to compare pre and post-treatment results of NRS scores;

McNemar test will be used to compare pre and post- treatment results of percentage pain relief and

reduction of analgesic dose; Wilcoxon signed rank test will be used for the comparison of DSM-IV; P

value < 0.05 will be considered as significant.