Wang M Y, Teitelbaum G P, Loskota W J, Eng D, Albuquerque F, Gruen J P
Department of Neurological Surgery, Los Angeles County Medical Center and University of Southern California, Los Angeles 90033, USA.
Neurosurgery. 2000 Apr;46(4):1009-12.
Infiltration of the brachial plexus with anesthetics can provide relief of upper-extremity pain from invasive cancer. Because the analgesia is short-lived, however, repeated invasive treatments are necessary. We describe the implantation of a catheter reservoir system, in which anesthetic injections through a subcutaneous port resulted in anesthetic infiltration of the brachial plexus.
A 47-year-old Hispanic man with squamous cell carcinoma of the larynx had undergone surgical resection, radiation treatment, and chemotherapy. Two years later, he had locally recurrent disease involving the brachial plexus, neck, and chest wall. The patient's pain was minimally responsive to narcotics, which also caused severe nausea and anorexia.
The brachial plexus was localized percutaneously with a needle electrode stimulator. Contrast injection under fluoroscopy confirmed entry into the plexus sheath. With use of the Seldinger technique, two Silastic catheters were placed within the brachial plexus and attached with a "Y" connector to a reservoir. The patient experienced complete relief of upper-extremity pain after a test injection with xylocaine. Thereafter, serial injections of bupivacaine with triamcinolone at 1-week intervals provided complete pain relief. After the treatments were initiated, the patient reported improved sleep and an improvement in his quality of life.
A catheter reservoir system for brachial plexus analgesia can provide safe and effective analgesia for upper-extremity pain. This technique negates the need for repeated invasive procedures and avoids the complications of neurolysis.
用麻醉剂浸润臂丛神经可缓解侵袭性癌症引起的上肢疼痛。然而，由于镇痛效果短暂，需要反复进行侵入性治疗。我们描述了一种导管储液器系统的植入，通过皮下端口注射麻醉剂可实现臂丛神经的麻醉浸润。
一名47岁患有喉鳞状细胞癌的西班牙裔男性接受了手术切除、放射治疗和化疗。两年后，他出现局部复发性疾病，累及臂丛神经、颈部和胸壁。患者的疼痛对麻醉剂反应甚微，且麻醉剂还引起严重的恶心和厌食。
用针电极刺激器经皮定位臂丛神经。在荧光透视下注射造影剂以确认进入神经丛鞘。采用Seldinger技术，将两根硅橡胶导管置于臂丛神经内，并用“Y”形连接器连接到一个储液器。患者在试验性注射利多卡因后上肢疼痛完全缓解。此后，每隔1周连续注射布比卡因和曲安奈德，疼痛完全缓解。开始治疗后，患者报告睡眠改善，生活质量提高。
用于臂丛神经镇痛的导管储液器系统可为上肢疼痛提供安全有效的镇痛。该技术无需反复进行侵入性操作，并避免了神经溶解的并发症。
