A Series of Stellate Ganglion Block for Ischemic Monomelic Neuropathy Chronic Ischemic Pain after Arteriovenous Shunt Surgery-A Case Report

一系列星狀神經節阻斷應用於上肢動靜脈管術後缺血性神經病變之病例報告

錢懿(Chien I) ； 謝炯昭(Chong-Chao Hsieh) ； 王建仁(Chien-Jen Wang) ； 陳太乙(Tai-I Chen) ； 盧奕丞(I-Cheng Lu) ； 湯振青(Chen-Chin Tang) ； 湯兆舜(Chao-Shun Tang)

《疼痛醫學雜誌》 19卷1期 (2009/03) Pp. 17-22

https://doi.org/10.29792/TTJP.200903.0003

摘要

一位51歲罹患糖尿病十餘年且合併腎衰竭之女性發生缺血性神經病變。左臂接受兩次動靜脈廖管手術，術後左前臂發生中重度疼痛，冰冷，持續超過半年。懷疑是缺血性神經病變，病患接受弱鴉片類藥物、抗癲癇藥物及維生素B12。然因疼痛控制不佳，轉介至疼痛科。我們安排一系列星狀神經節阻斷，藉以改善上肢之循環及疼痛，另給予舌下buprenorphine應付突發性疼痛。以紅外線攝溫儀評估週邊循環；以疼痛量表、疼痛頻率與持續時間評估疼痛控制。結果患者於一系列治療後得到較滿意之疼痛控制。

關鍵字

缺血性神經病變 ； 星狀神經節阻斷 ； 紅外線攝溫儀

並列摘要

We report a case of ischemic monomelic neuropathy (IMN) occurring in a 51 years old diabetic female patient with end-stage renal disease. She underwent arteriovenous (A-V) shunt creation but subsequent severe steal syndrome developed. Unfortunately, she complained moderate to severe left forearm pain and a cold hand after revision of A-V shunt for more than 6 months. Under the impression of ischemic neuropathy, she was prescribed with weak opioid, antiepileptics and mecobalamine. She was transferred to our pain clinic because of inadequate pain control. We arranged left side stellate ganglion block once per week for 2 months to improve upper arm circulation and relieve pain and buprenorphone also added for breakthrough pain. Outcome measurements for peripheral circulation and chronic pain were done by infrared thermography and numerical rating scale respectively. Gradually, her intractable pain was controlled with much satisfaction.

並列關鍵字

ischemic neuropathy ； stellate ganglion block ； infrared thermography