Continuous blockade of both brachial plexus with ropivacaine in phantom pain: a case report.
A 39-year-old patient developed phantom pain after amputation of both upper arms following a burn injury. The pain did not respond to naproxen, morphine, carbamazepine, amitriptyline, calcitonin or transcutaneous electrical nerve stimulation (TENS). At the 39th post-operative day an axillary catheter was placed on the right side, as well as an interscalene catheter on the left. Ropivacaine 0.2% was infused, starting with a rate of 4 ml/h, that was increased to 6 ml/h during the subsequent 6 days. Within 20 min of catheter placement complete pain relief was achieved. The patient did not need any other analgesics and remained painfree for 7 months. Neither motor block, nor any other side effects occurred during the infusion of ropivacaine 0.2%. Thus, the patient not only received analgesia, but also got an effective treatment of established phantom pain. A similar approach with bupivacaine may not have been feasible, because of the possibility of toxic side effects. Ropivacaine is a long-acting local anaesthetic which is less toxic than bupivacaine and has the additional advantage of producing less motor-blockade in the concentration used, so the patient was able to move actively without experiencing any pain.
Lierz
Peter
P
Department of Anaesthesiology and General Intensive Care Medicine B, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria Department of Surgery University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Schroegendorfer
Klaus
K
Choi
Seung
S
Felleiter
Peter
P
Kress
Hans-Georg
HG
D000328:Adult; D000577:Amides / Q000009:adverse effects / Q000627:therapeutic use*; D000671:Amputation, Surgical; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D001132:Arm / Q000601:surgery; D001917:Brachial Plexus / Q000187:drug effects*; D004334:Drug Administration Schedule; D006801:Humans; D008297:Male; D009407:Nerve Block; D010591:Phantom Limb / Q000188:drug therapy*; D000077212:Ropivacaine; D016896:Treatment Outcome
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine