用類固醇注射成功治療腹腔神經叢燒灼後疼痛

Successful Treatment of Postceliac Neurolysis Pain with Steroid Injection: A Case Report

腹腔神經叢阻斷對上腹部的癌症內臟痛是種有效且常用的方式，尤其是對於胰臟癌，但用酒精燒灼後疼痛也在腹腔神經叢阻斷被報導過，我們提供一種方式來治療這種酒精燒灼後疼痛。病例報告：一位49歲婦女患有胰臟尾部癌與多處轉移，由於劇烈的腹部頭痛與背部轉移痛而執行腹腔神經叢酒精神經燒灼術，病人的左腹部疼痛改善顯著但是反而引發右側腹部疼痛，而右側腹部疼痛是之前沒有的，所以我們認為是酒精注射後所引起的神經燒灼痛。我們又執行了另一次的右側腹腔神經叢類固醇注射之後右側腹部疼痛戲劇性的改善了，而在腹腔神經叢阻斷後病人只用少量的服藥就能不痛了。討論：腹腔神經叢阻斷對於胰臟癌的腹痛蠻有效的，但還是有一些輕微的副作用，例如酒精神經燒灼後的神經痛，這種疼痛常會使病人對於腹腔神經叢阻斷的滿意度降低，而類固醇的抗發炎的作用正好可以適用於酒精對於神經的發炎刺激性，降低酒精神經燒灼術後疼痛，進而增進腹腔神經叢阻斷的止痛效果總結來說，酒精神經燒灼術後疼痛可以用類固醇注射來治療，並且可能增加腹腔神經叢阻斷的效果。

A 49-year-old woman with a pancreatic tail tumor and multiple metastasesunderwent alcohol celiac plexus neurolysis for severe left-side abdominal painradiating to the back. After the block, the patient had excellent pain relief in the leftabdomen, but the block induced right abdominal pain, which she did not havebefore the neurolytic celiac plexus block (NCPB). Postinjection pain of alcoholneurolysis was suspected. We performed another right-side transcrural insertion toinject steroid into the celiac ganglion. The patient reported dramatic relief of theright-side abdominal pain after the steroid injection. Finally, the patient was painfree with minimal oral drugs after the NCPB. In conclusion, postinjection alcoholneurolysis pain can be treated with steroid injection, which may increase theefficacy of NCPB.