Wilkes Denise, Ganceres Natalie, Solanki Daneshvari, Hayes Maureen
Department of Anesthesiology and Pain Management, University of Texas Medical Branch, Galveston, TX 77555, USA.
Clin J Pain. 2008 Oct;24(8):736-9. doi: 10.1097/AJP.0b013e318170d758.
Phantom limb pain can be challenging to treat. We present a patient who developed severe phantom limb pain after revision of her lower extremity amputation due to the continued progression of peripheral vascular disease. Multiple treatment modalities had been tried without success. Pulsed radiofrequency has been successfully used to manage a number of pain syndromes.
The present case report describes the use of pulsed radiofrequency treatment for phantom limb pain.
The authors initially preformed regional blocks of femoral and sciatic nerve with 0.375% bupivicaine 15 cc and 50 microg clonidine to control the patient's pain. The blocks provided good pain relief but with limited duration. Based on reports of prolonged pain relief provided by pulsed radiofrequency treatment for other chronic pain conditions such as lumbrosacral spondylosis, we decided to apply this treatment to the patient's sciatic nerve. The patient underwent pulsed radiofrequency treatment with 2 cycles of 120 seconds at 42 degrees, pulse rate of 2 pulse/second, and pulse duration of 20 milliseconds.
Our report shows that the sciatic nerve block with bupivicaine and clonidine, initiated approximately 3 years after amputation, produced modest short-term relief. The pulsed radiofrequency treatment resulted in long-term relief of phantom limb pain. The patient was able to wean herself off all oral medications and has been pain free for 4 months.
幻肢痛的治疗颇具挑战性。我们报告一例患者，因外周血管疾病持续进展，在下肢截肢翻修术后出现严重幻肢痛。尝试了多种治疗方法均未成功。脉冲射频已成功用于治疗多种疼痛综合征。
本病例报告描述了脉冲射频治疗幻肢痛的应用。
作者最初用15毫升0.375%布比卡因和50微克可乐定对股神经和坐骨神经进行区域阻滞，以控制患者疼痛。阻滞提供了良好的疼痛缓解，但持续时间有限。基于脉冲射频治疗其他慢性疼痛疾病（如腰骶部脊柱病）可提供长期疼痛缓解的报道，我们决定将此治疗应用于该患者的坐骨神经。患者接受了脉冲射频治疗，在42度下进行2个120秒周期的治疗，脉冲频率为2脉冲/秒，脉冲持续时间为20毫秒。
我们的报告显示，截肢后约3年开始的布比卡因和可乐定坐骨神经阻滞产生了适度的短期缓解。脉冲射频治疗导致幻肢痛长期缓解。患者能够逐渐停用所有口服药物，且已无痛4个月。
