骨盤内腫瘍による神経障害性疼痛に対しエコーガイド下坐骨神経ブロックが有効であった1症例  [in Japanese] Successful elimination of intractable lower limb neuropathic pain by pelvic tumor invasion using ultrasound-guided sciatic nerve block  [in Japanese]

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Abstract

骨盤内腫瘍増大による神経障害性疼痛に対し従来の薬物療法では十分な除痛が得られず, エコーガイド下坐骨神経ブロックで良好な鎮痛が得られた症例を経験したので報告する. 【症例】60歳代, 男性. 骨盤内腫瘍による神経圧迫が原因の痛みに対しフェンタニル貼付剤10.5mg, ガバペンチン1,600mg/日, エトドラク400mg/日, アミトリプチリン30mg/日まで増量したが, 眠気が増加するのみで十分な鎮痛効果が得られなかった. エコーガイドで坐骨神経に0.1%ロピバカイン5ml/時で持続投与することで痛みが軽減し, フェンタニル貼付剤8.4mg, ガバペンチン800mg/日, アミトリプチリン10mg/日まで減量が可能となり, 眠気も軽減することができた. 従来の末梢神経ブロックと異なりエコーを使用することで安全かつ確実に鎮痛が得られるため, 全身状態が悪い状況であっても神経ブロックの選択が可能となる. Palliat Care Res 2011; 6(1): 313-315

We report a case whose left lower limb neuropathic pain accompanied by pelvic tumor invasion was remarkably eliminated by ultrasound-guided sciatic nerve block. <b>Case report</b>: The subject was a sixty year old male. Pharmacological therapy was given according to the WHO analgesic ladder, but his left lower limb pain failed to respond to drugs. His intractable lower limb neuropathic pain was alleviated by ultrasound-guided sciatic nerve block. Drug delivery can be achieved with a percutaneous catheter and a disposable infusion pump. Infusions were run at 5mlh<SUP>-1</SUP> with 0.1% ropivacaine. <b>Conclusion</b>: Neuropahic pain is sometimes hard to be controlled only by opioids or adjuvant analgesics, but there is a possibility of providing pain relief by combination use with nerve blocks. Interventional techniques can be highly effective but also have the potentiality to produce significant adverse effects. Many patients have factors which would be considered a near absolute contra-indication to the use of nerve blocks such as immuno-compromise or impairment of coagulation. Skillful application of peripheral neural blockade with ultrasound imaging broadens the options for providing optimal pain management. Palliat Care Res 2011; 6(1): 313-315

Journal

  • Palliative Care Research

    Palliative Care Research 6(1), 313-315, 2011

    Japanese Society for Palliative Medicine

Codes

  • NII Article ID (NAID)
    130000858764
  • Text Lang
    JPN
  • Data Source
    J-STAGE 
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