Specialty Care Associates

Treatment of Orofacial Pain with Lower Cervical Bupivacaine Injections

Acad Emerg Med Volume 12, Number 5_suppl_1 157, © 2005 Society for Academic Emergency Medicine

ANESTHESIA

Treatment of Acute Orofacial Pain with Lower Cervical Intramuscular Bupivacaine Injections: A One-year Retrospective Review of 113 Patients

Larry B. Mellick, Gary A. Mellick and Armin Oskouei

Medical College of Georgia: Augusta, GA

ABSTRACT

Background: The injection of anesthetic (1.5 mL bupivacaine 0.5%) into the paravertebral musculature bilateral to the seventh cervical spinous process has previously been reported to relieve headaches as well as orofacial pain. Objective: We present preliminary data reflecting one year's experience using the lower cervical (C6–C7) bilateral paraspinous deep intramuscular injection with bupivacaine (0.5%) to treat acute orofacial pain of various etiologies in an academic emergency department (ED) setting. Methods: A retrospective review of over 700 ED patients coded as having had an anesthetic injection between June 30, 2003, and July 1, 2004, was accomplished. Additional patients were identified following a systematic review of patients with specific orofacial pain complaints presenting during the same period of time. All patients 18 years of age or older who had undergone paraspinous intramuscular injection with bupivacaine for the treatment of acute orofacial pain (odontalgia, mandible fractures, mandible dislocation, temporomandibular disorders, otitis media and externa, facial cellulitis, corneal abrasions, glaucoma, etc.) were included in this retrospective review. Results: Relief of orofacial pain was noted in 70 of 113 patients (61.9%). Another 38 patients (33.6%) reported partial relief from their orofacial pain and were given additional medications to attain complete relief. Five patients (4.4%) reported no significant pain relief following the injection. Orofacial pain relief was typically rapid with many patients reporting complete or partial pain relief in 5 to 15 minutes. A total of 108 of 113 patients (95.6%) reported pain reduction in response to the procedure. Conclusions: Our preliminary data suggest that the intramuscular injection of small amounts of bupivacaine into the paraspinous muscles bilateral to the C6 or C7 spinous process appears to relieve acute orofacial pain in the ED