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. |