Transient phantom limb pain following high thoracic erector spinae plane block in an amputee
- PDF / 250,857 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 21 Downloads / 225 Views
CORRESPONDENCE
Transient phantom limb pain following high thoracic erector spinae plane block in an amputee Abdelghafour Elkoundi, MD . Mehdi Samali, MD . Amine Meskine, MD . Hicham Bakkali, PhD . Hicham Balkhi, PhD . Mustapha Bensghir, PhD
Received: 5 June 2020 / Revised: 19 June 2020 / Accepted: 19 June 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, Reactivation or induction of phantom limb pain following regional anesthesia (RA) is rarely encountered in clinical anesthesia practice.1,2 We describe a patient who experienced phantom limb pain after receiving an erector spinae plane (ESP) block. To our knowledge, no such event has been reported with this technique. Written informed consent was obtained from the patient for this report. After sustaining an injury during a motor vehicle accident, a 42-yr-old man (American Society of Anesthesiologists physical status I) had a left aboveelbow amputation under general anesthesia. He had previously only reported surgical stump site pain in the immediate postoperative period that was well managed with oral analgesics (paracetamol and tramadol). There was no evidence of persistent upper-extremity phantom sensation or phantom pain. Three weeks after the amputation, he returned to the hospital for surgical revision of the stump site that had become infected. The procedure was performed under general anesthesia. To provide postoperative analgesia, we performed a preoperative ultrasound-guided ESP block at the T2 level with 20 mL of 0.25% bupivacaine. The sensory block was assessed with pin-prick and cold tests, which showed that the block had developed in the upper extremity with a dermatomal coverage from the C5 to T3 level. Concomitantly, mild paresthesia was produced in the patient’s ‘‘phantom’’ fingers.
A. Elkoundi, MD (&) M. Samali, MD A. Meskine, MD H. Bakkali, PhD H. Balkhi, PhD M. Bensghir, PhD Department of Anesthesiology and Critical Care, Military Teaching Hospital Mohammed V, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco e-mail: [email protected]
Following the stump revision (during which he received 150 lg fentanyl), the patient was monitored in the postanesthesia care unit. Thirty minutes later, the patient complained of excruciating arm pain. A new assessment showed complete sensory block of the upper extremity. Nevertheless, the patient reported a severe burning pain sensation in the anatomically absent left arm. He received a further 50 lg fentanyl and a total of 8 mg morphine with no change in the pain. Midazolam 2 mg iv was given along with 60 mg lidocaine iv, which reduced the phantom pain from 10 to 4 (0 = no pain; 10 = worst possible pain). After eight hours, after the sensory block dissipated, the patient complained of slight stump pain, which was managed with intravenous acetaminophen. The phantom pain also decreased gradually and resolved about one hour later. The patient made a good recovery and was discharged home without any further episodes of phantom pain. Several reports hav
Data Loading...
