[Management of severe pain after extended maxillectomy in a patient with carcinoma of the maxillary sinus].
We treated a 65 year-old man with severe facial pain after extended maxillectomy due to carcinoma of maxillar sinus. He had been suffering from pain at rest, on mastication, or at treatment of surgical wound. Various kinds of analgesics had been tried, but his pain did not disappear. At 17 weeks after the operation, he came to our pain clinic. Because his pain was thought to be due to reflex sympathetic dystrophy (RSD), stellate ganglion blocks (SGB) were performed. After 5 administrations of SGB, pain was reduced markedly but the pain at treatment of wound persisted. We thought that persistent pain would need trigeminal nerve block. Then Gasserian ganglion block was performed directly through an open wound after the operation. After the Gasserian ganglion block, the pain was diminished remarkably. He could tolerate procedures for facial prosthesis. Pain control after the operation in this patient was very efficient to improve his quality of life. Serum concentrations of catecholamines, serotonin and substance P were measured. The levels of norepinephrine and serotonin are related to the mechanism of pain as seen in this patient.
Iwade
M
M
Department of Anesthesiology, Tokyo Women's Medical College.
Fukuuchi
A
A
Kawamata
M
M
Nomura
Y
Y
Mukubo
Y
Y
Suzuki
H
H
Yoshiwara
T
T
D000368:Aged; D001340:Autonomic Nerve Block; D005157:Facial Pain / Q000628:therapy*; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000601:surgery*; D008444:Maxillary Sinus Neoplasms / Q000601:surgery*; D010149:Postoperative Pain / Q000628:therapy*; D013233:Stellate Ganglion