間歇性斜角肌間神經阻斷可使複雜性區域疼痛症候群病人得到長期疼痛緩解——病例報告

Intermittent Interscalene Blockade Can Provide Long Term Pain Relief in a Patient with Complex Regional Pain Syndrome

一位56歲的男性因為37年前左臂神經叢穿刺傷而產生複雜性區域疼痛症候群，自那時候起就產生嚴重的抽痛，而他也嘗試了很多治療方法但是並沒有效果。慢慢的他成了一個物質濫用者而且也數度嘗試自殺。後來他到我們疼痛門診求診。在診察中發現他整個左手臂腫漲，並伴隨毛髮增多，肌肉萎縮及低溫現象。在解釋後，我們先幫他用1%lidocaine 20m1做斜角肌間神經阻斷術，因疼痛程度在注射後2週內減輕許多，他2週後要求做另一次的斜角肌間神經阻斷術。之後我們視他疼痛程度緩解的狀況每隔2～4週幫他做斜角肌神經阻斷術。在做了21次的阻斷後，他的疼痛程度降為0並且已經不需要再繼續做神經阻斷術了，這個病人在一年內的門診追蹤內非常滿意治療效果，這個病人治療的方法還有可能的機轉將會被討論。

A 56-year-old male suffered from Complex Regional Pain Syndrome (CRPS)on his left brachial plexus due to penetrating injury thirty-seven years ago.Intractable severe shooting pain started since then and a lot of medical methodswere done but in vain. He gradually became a drug abuser and had several suicideattempts. He was then transferred to our pain clinic for help. In our pain clinic,skin atrophy, increased hair growth, muscle atrophy and hypothermia werefounded and with the fullness in pain intensity (visual analog scale 10). After ourexplanation, he decided to be performed interscalene blockade (ISB) firstly withthe regiment of 1% lidocaine 20 ml. The pain intensity was decreased in thefollowing 2 week and he asked for further injection due to excellent response ofISB. We then performed the further injection of ISB every 2-4 weeks according tohis symptom-free period. After total 21 injections of ISB, the pain intensitybecame zero and no further injection needed. The patient satisfied with thistreatment after one-year follow-up in our pain clinic. The treatment of this case andthe possible mechanisms were discussed.