合併使用Lidocaine及CloMdine於腰椎交感神經阻斷術有效減緩複雜區域疼痛症候群第一型病患痛覺之病例報告

Repeated Lumbar Sympathetic Blockade with Lidocaine and Clonidine Attenuates Pain in Complex Regional Pain Syndrome Type 1 Patients-- A Report of Two Cases

對於下肢患有複雜區域疼痛症候群的病人，一般皆以局部麻醉劑重複施予腰椎交感神經阻斷術來加以治療。然而，在重複多次後，病人症狀常無可避免地會再次復發。Clonidine是一種腎上腺甲2型受體的致效劑，同時具有麻醉及止痛作用，在合併局部麻醉劑使用時，藉由中樞及周邊的作用機轉，亦可增強中樞及周邊神經阻斷的效果。所以不難理解為何clonidine會被使用於病態神經痛及持續性交感神經痛等這類慢性疼痛的治療上。我們報告兩位患有複雜區域疼痛症候群的病人，其中一位在給予多次腰椎交感神經阻斷術治療後，其症狀復發，我們嘗試在交感神經阻斷術時合併使用lidocaine及clonidine，對於痛覺及臨床症狀明顯獲得改善。因此，另一位病人我們一開始就合併使用兩個藥物，結果也同樣獲得明顯改善。

Repeated lumbar sympathetic blockade (LSB) with local anesthetics is generally used in complex regional pain syndrome (CRPS) of the lower extremities if the initial block has been successful. However, the symptoms of CRPS may inevitably recur in spite of repeated LSB. Clonidine, an α2-adrenoceptor agonist, has both anesthetic and analgesic sparing effects, and when added to local anesthetics may enhance peripheral and central neural block due to its local or central analgesic effects. It is reasonable that clonidine has been used in chronic pain conditions such as neuropathic and sympathetically maintained pain. Here we report two cases of CRPS type 1 who got excellent analgesia and alleviation of clinical symptoms after receiving an LSB with lidocaine and clonidine.