Paqueron Xavier, Lauwick Séverine, Le Guen Morgan, Coriat Pierre
Department of Anesthesiology, Centre Hospitalier Universitaire Pitié-Salp|$$|Axetrière, Assistance Publique H|$$|Axopitaux de Paris, Université Pierre et Marie Curie, Paris, France.
Reg Anesth Pain Med. 2004 Mar-Apr;29(2):168-71. doi: 10.1016/j.rapm.2003.12.017.
The objective of this article is to describe a late-onset phantom-limb pain during a continuous analgesic popliteal nerve block after foot surgery and its alleviation and recurrence when stopping and resuming the local anesthetic infusion.
A 29-year-old woman undergoing a left hallux valgus repair received a continuous popliteal sciatic nerve block for postoperative analgesia. Postoperatively, 6 hours after the commencement of a ropivacaine 0.2% infusion, she reported feelings of tingling, clenching pain, and missing-limb sensation below the ankle. The surgical site remained painless. Sensation elicited by touch and propioception were normally perceived. Only sensations for pinprick and heat were impaired. The ropivacaine infusion was stopped, followed 2.5 hours later by the complete regression of any abnormal sensation. Meanwhile, pain at the surgical site was scored at 50 mm on a 100-mm visual analogic scale. As the infusion of ropivacaine was resumed, the abnormal sensations reappeared. The catheter was removed, and abnormal sensations again disappeared. The patient was discharged from hospital without further complications.
This observation suggests that phantom-limb pain can be of late-onset and might occur during a continuous infusion of low-concentration local anesthetic responsible only for an analgesic block, as shown by the fact that only thermal and pinprick sensations, known to depend on Adelta-fibers and C-fibers, were altered. Therefore, this case contradicts the usual belief that a profound block is necessary to elicit phantom-limb pain.
本文旨在描述足部手术后连续腘神经阻滞期间出现的迟发性幻肢痛，以及停止和恢复局部麻醉药输注时疼痛的缓解和复发情况。
一名29岁接受左拇外翻修复手术的女性患者，术后接受连续坐骨神经腘神经阻滞镇痛。术后，在开始输注0.2%罗哌卡因6小时后，她报告踝关节以下有刺痛、紧握样疼痛和肢体缺失感。手术部位无疼痛。触觉和本体感觉引发的感觉正常。仅针刺觉和热觉受损。停止罗哌卡因输注，2.5小时后任何异常感觉完全消退。与此同时，手术部位的疼痛在100毫米视觉模拟量表上评分为50毫米。随着罗哌卡因输注的恢复，异常感觉再次出现。拔除导管后，异常感觉再次消失。患者出院时无进一步并发症。
该观察结果表明，幻肢痛可能是迟发性的，并且可能在仅用于镇痛阻滞的低浓度局部麻醉药连续输注期间发生，这一事实表明只有已知依赖于Aδ纤维和C纤维的热觉和针刺觉发生了改变。因此，该病例与通常认为需要深度阻滞才能引发幻肢痛的观点相矛盾。
