Ultrasound-guided sciatic neuroma block for treatment of intractable stump pain.
A 61-year-old patient with severe stump pain required hospitalization and intravenous opioids for pain control. After evaluation by our anesthesia pain management service, we concluded that the patient had a neuroma at the site of sciatic nerve transection and that injection of a mixture of local anesthetic and corticosteroid at the site of the neuroma was the most appropriate management. Because the alternative methods of nerve localization (eg, motor stimulation, paresthesia) were unlikely to be successful, we felt that the most reliable way to accomplish this task was to use live ultrasound guidance. After a series of 4 ultrasound-guided blocks with bupivacaine and methylprednisolone acetate, the patient's pain was alleviated to the point at which it was managed with occasional doses of oral opioids.
Fischler
Adam H
AH
Department of Anesthesiology, University of Connecticut School of Medicine, Farmington, CT 06030-2015, USA. adamfischler@sbcglobal.net
Gross
Jeffrey B
JB
D000672:Amputation Stumps / Q000000981:diagnostic imaging* / Q000294:innervation*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007866:Leg / Q000294:innervation; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009463:Neuroma / Q000188:drug therapy*; D010148:Intractable Pain / Q000188:drug therapy*; D012584:Sciatic Nerve / Q000187:drug effects*; D014463:Ultrasonography
D000779:Anesthetics, Local; D005938:Glucocorticoids; D008775:Methylprednisolone; D002045:Bupivacaine