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Sayaka Sugibe, Aiko Maeda, Sho Shinotuka, Ken Yamaura
, Brachial plexus block improved refractory pain due to intraoperative position-related nerve injury: a case report., The 38th kyushu Pain Society Meeting, 2020.02, Background: Peripheral nerve injury is a significant perioperative complication. Brachial plexus injury happens to occur as a result of inappropriate traction or compression of the brachial plexus in association with the forced intraoperative neck-arm position. We report a case of intraoperative position-related brachial plexus injury, whose symptom was improved by brachial plexus block.
Case description: A 23-years-old man underwent thoracoscopic resection for an anterior mediastinal tumor. It took 8 hours under the right prone position with his left arm fixed at the shoulder height and his neck slightly extended. Immediately after the surgery, the patient complained of severe pain with paralysis and numbness of left upper extremity. Magnetic resonance neurography showed swollen brachial plexus probably due to inflammation. According to the onset and image findings, it was diagnosed as brachial plexus injury. His symptoms were not improved by conservative treatments including medications (mecobalamin, pregabalin 300mg/day, tramadol 200mg/day). He was referred to our pain clinic 50 days after surgery. He presented with severe pain from the left forearm to the thumb, in which the pain score was 8 out of 10. We decided to perform the ultrasound-guided brachial plexus block (1% mepivacaine + dexamethasone 3.3mg) to control the inflammation. After the five times blocks, although the numbness remained, the pain score of his left upper extremity was improved to 0.
Conclusions: Brachial plexus block could improve intraoperative position-related refractory pain possibly by amelioration of the injured nerve inflammation.
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| 2. |
Aiko Maeda, Hiroaki Shiokawa, Sumio Hoka, Ken Yamaura
, Spinal Cord Stimulation Improved Motor Dysfunction in Two Patients with Complex Regional Pain Syndrome.
, 11th congress of the European Pain Federation EFIC, 2019.09, Background: Complex regional pain syndrome (CRPS) is a painful condition that most often affects one limb with various other symptoms such as changes in skin color and nail growth, muscle atrophy, and stiffness of affected joints. CRPS patients suffer from intractable pain as well as severe functional impairment, which deteriorate the quality of life. Several therapeutic modalities such as physical therapy, rehabilitation and medications have been reported to be effective for CRPS. Spinal cord stimulation (SCS) is also listed as a choice of treatment for refractory CRPS. It has been shown that SCS provides a tingling sensation in the painful area leading to pain relief, but there is a lack of enough information regarding the effect of SCS on functional improvement.
Method: we report two cases of CRPS, whose functional impairment could be satisfactorily improved by SCS.
Result: Case 1: A 44-year-old man suffered from CRPS at the right upper limb for two years. He could only slightly move his right hand due to stiffness of the joints. After SCS implantation at the cervical cord, the movement has improved and his right grip strength has significantly increased. Case 2: A 62-year-old woman developed CRPS at the left lower limb two years ago. She had marked disturbance on walking due to bone demineralization and muscle atrophy. After SCS implantation at the thoracic cord, her lower limb function has significantly improved until she could walk.
Conclusions: SCS trials would have a possibility to ameliorate the motor dysfunction of CRPS.
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