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

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

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。左臂接受雨次動脈廔管手術，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。

We report a case of ischemic monomelic neuropathy (IMN) occurring in a 51years old diabetic female patient with end-stage renal disease. She underwentarteriovenous (A-V) shunt creation but subsequent severe steal syndromedeveloped. Unfortunately, she complained moderate to severe left forearm pain anda cold hand after revision of A-V shunt for more than 6 months. Under theimpression of ischemic neuropathy, she was prescribed with weak opioid, antiepilepticsand mecobalamine. She was transferred to our pain clinic because ofinadequate pain control. We arranged left side stellate ganglion block once perweek for 2 months to improve upper arm circulation and relieve pain andbuprenorphone also added for breakthrough pain. Outcome measurements forperipheral circulation and chronic pain were done by infrared thermography andnumerical rating scale respectively. Gradually, her intractable pain was controlledwith much satisfaction.