蜘蛛網膜下腔注射酒精治療幻肢痛之個案報告

Alcohol Spinal N eurolysis In Eliminating Phantom Limb Pain-A Case Report

前言：幻肢痛通常是長期傷口疼痛的後遺症。雖然有很多建議的治療方法，可是對這位病人效果有限。在兩年內嘗試著各種方法治療後，病人最後選擇背根神經節燒灼術。病歷報告：41歲女性，粉碎性開放性骨折被截肢。截肢後，她一直覺得幻肢痛。幻肢嚴重疼痛到病人有自殺的傾向。在疼痛門診試過各種的止痛方法來治療病人，可是效果不好。在跟病人詳細討論後，病人選擇背根神經節燒灼術。我們在T9-10打入O.lml,o.協等比重的bupivacaine於蜘蛛膜下腔，確定疼痛位置無誤後。每兩分鐘慢慢的打入0.05ml,100革的己醇總共四次。之後病人被要求維持這一個姿勢至少30分鐘。做完第一次，她覺得背根神經節燒灼術很有效也無副作用。兩個禮拜後燒灼Tll-Ll，兩個禮拜再燒灼Ll-L3。之後她覺得幻肢痛大有改善。討論：雖然文獻曾報過背根神接節燒灼術可能導致肌肉無力、膀AA；排尿困難以及影響腸冒蜻動。可是我們先用等比重的bupivacaine確定位置無誤之候，再施予背根神接節燒灼術。更何況病人患肢已截肢，並靠輪椅行動，所以不會嚴重導致患肢肌肉無力之症狀。而且我們慢慢分三次治療，在確定病人無此副作用後再進行下一次的治療。結論：硬腦膜下腔100%酒精之背根神經飾燒灼術可以很有效的治療幻肢痛。

We report the efficacy of spinal alcohol neurolysis for pain control in a patient with a history of phantom limb pain following above-knee amputation. She had severe stump and phantom pain, even receiving 60 mg morphine, 1200mg gabapentin, and 2 mg clonazepam. She underwent Tl0-11, Tll-Ll and Ll-L3 spinal alcohol neurolysis sequentially every two weeks. There were no incidents of hypotension, cardiac arrhythmia, or respiratory difficulty, during the procedures. The pain score (from 0 to 10) following three neurolyses was 2. The patient required a total of 200 mg of tramadol postoperatively. The patient did not report phantom pain for 6 months after neurolysis.