Collateral meridian acupressure therapy is effectively to complex regional pain syndrome (CRPS)-like hyperalgesia induced by post-epidural block

遠絡治療立即緩解硬膜外麻醉後造成下肢之類複雜性區域疼痛徵候群

李銘家(Min-Jia Li) ； 葉春長(Chun-Chang Yeh) ； 吳之芾(Wu Zhi-Fu) ； 汪志雄(Chih-Shung Wong)

《疼痛醫學雜誌》 27卷2期 (2017/09) Pp. 92-98

摘要

Objectives: This report demonstrates that collateral meridian acupressure therapy (CMAT) provided an immediate and complete relief of CRPS-like symptoms, including muscle pain and swollen, tingling sensation, over bilateral lower leg calf after epidural anesthesia for laparoscopic herniorrhaphy. Clinical Features: A 59-yr-old male (height 170 cm and weight 60 kg) was diagnosed of right inguinal hernia and underwent epidural anesthesia for laparoscopy herniorraphy. Epidural needle was inserted via L3-4 midline and advanced cephalic for 5 cm, 2% lidocanie 10 ml plus 100 μg fentanyl were injected with the highest block level at T6, 2 mg of midazolam was give for sedation and 25mg of pethedine was given for shivering. The surgery was lasted for one hour. The epidural catheterization and operation were smooth and uneventful and patient was discharged on postoperation day 3. Unfortunately after discharge, the patient suffered from bilateral lower leg calf muscle pain and swollen with tingling sensation when standing on both feet, particularly over the right lower leg. The pain could not be relieved by oral pain killers, including acetaminophen, ketorolac and tramadol. It was temporarily reduced when laid down on bed. As the symptoms continued, the patient visited his surgeon and asked for help on day 3 after discharge, and consequently he was referred to our anesthesia department for symptom relief. After general physical and neurological examination, no abnormal findings were found, except higher skin temperature over his right lower leg calf muscle. CAMT with laser was applied over governor-vessel (at level of L1~S4) and acupressure (remove and enhance manipulation) over bilateral AxIII/AyIII//c+a+cb+4/3!6! with acupressure sticks. Dramatically, all of patient's symptoms were relieved immediately after CMAT, including pain and swelling and tingling sensations, even when standing and walking. The patient stayed at our postoperative recovery room for another hour and went home with all symptoms free. Three days later, the patient remained symptoms-free. Conclusion: This case report demonstrates that CMAT effectively relieved the post lumbar epidural anesthesia-related CRPS-like pain, it suggests that CMAT may be an alternative therapy for the epidural neuraxial block induced CRPS-like symptoms.

關鍵字

Collateral Meridian Acupressure Therapy ； Epidural anesthesia ； CRPS-like hyperalgesia

並列摘要

本病例是報告病人接受腹股溝疝氣收術在硬膜外麻醉後引發下肢類複雜性區域疼痛微候群，於接受一般之止痛藥物治療無效後，經由遠絡治療而立即緩解其神經病理性之疼痛。一個59歲男性病人（170公分高，體重60公斤）因診斷右側腹股溝疝氣入院接受腹腔鏡腹股溝疝氣修補手術。硬膜外麻醉是由腰椎第三，四節脊椎中線間隙進針，確定進入硬膜外腔後硬膜外導管向頭側置入5公分，然後注入2％ lidocanie 10毫升與100微克fentanyl，麻醉高度到達胸椎第六節。術中2毫克midazolam鎮靜與25毫克pethedine減緩發抖。手術進行一小時後順利完成並於3天後出院。但出院後發現兩側小腿腫脹與疼痛合併麻剌感，尤其是站立時，右腿比左腿明顯。而一般的常規止痛藥acetaminophen，ketorolac和tramadol完全無任何效果。當躺下則可減緩疼痛與腫脹。病人因此會診麻醉科處置。身體檢查除兩小腿腫脹，觸診時皮膚有溫熱感與膚色較暗外，並無其他異常（包含神經檢查），右側較左側明顯；疼痛分數是7分為（右側）和4分（左側）。我們診斷是病人之督脈（L1～S4）之阻滯而產生的病態。以雷射遠絡治療其任脈（同L1～S4之高度）合併相對穴位按壓兩側AxIII/AyIII/c+a+cb+4/3!6!（補瀉手法）。經治療後病人產生立即之症狀緩解，疼痛分數為零，其他之症狀也立即消失，再經平躺休息30分鐘後，即下床步行回家。三天後電話詢問病人仍無任何症狀。結論：本病例報告再次証實遠絡治療之有效性；當遇臨床類似情況常規治療無效時之另一種選擇。

並列關鍵字

穴位按壓 ； 硬膜外麻醉 ； 類複雜性區域疼痛徵候群