Kishikawa Hiroaki, Wajima Zen'ichiro, Shitara Toshiro, Shimizu Toru, Adachi Hitoshi, Sakamoto Atsuhiro
Department of Anesthesiology, Nippon Medical School.
Department of Anesthesiology, Tokyo Medical University Hachioji Medical Center.
J Nippon Med Sch. 2017;84(4):183-185. doi: 10.1272/jnms.84.183.
Deafferentation pain induced by subarachnoid block (SAB) is rare, but it can appear in the form of recurrent phantom lower limb pain, new acute-onset stump pain in amputees, lower limb pain in patients with tabes dorsalis, and neuropathic pain. We have previously reported that thiopental is an effective treatment for deafferentation pain induced by therapeutic SAB applied to treat neuropathic pain of central origin. Here, we report the case of an amputee who developed new stump pain in his lower limb immediately after subarachnoid tetracaine was administered prior to appendectomy. A 51-year-old man who had previously undergone right below-knee amputation for acute arterial thrombosis, and who had not previously experienced chronic phantom limb or stump pain, was scheduled for emergency open appendectomy. For anesthesia, we induced SAB with a hyperbaric tetracaine solution. No paresthesia occurred during administration. However, the patient immediately complained of severe, lightning-bolt pain in the right lower limb stump after the SAB was established. He was given intravenous pentazocine, which promptly resolved the pain. Appendectomy was then performed under sedation using intravenous midazolam. The patient did not experience further deafferentation pain during his hospital stay and has reported no stump pain since discharge from the hospital. This case report suggests that SAB induces deafferentation pain in some patients and that this unusual pain can be treated with pentazocine.
蛛网膜下腔阻滞（SAB）引起的去传入性疼痛较为罕见，但可表现为复发性幻肢下肢痛、截肢者新出现的急性残端痛、脊髓痨患者的下肢痛以及神经性疼痛等形式。我们之前曾报道，硫喷妥钠是治疗因用于治疗中枢性起源神经性疼痛的治疗性SAB所引起的去传入性疼痛的有效药物。在此，我们报告一例截肢患者的病例，该患者在阑尾切除术前行蛛网膜下腔注入丁卡因后立即出现了下肢新的残端痛。一名51岁男性，既往因急性动脉血栓形成接受了右膝下截肢手术，此前未曾经历过慢性幻肢或残端痛，此次计划行急诊开放性阑尾切除术。为实施麻醉，我们用重比重丁卡因溶液诱导蛛网膜下腔阻滞。给药过程中未出现感觉异常。然而，在蛛网膜下腔阻滞建立后，患者立即诉说右下肢残端出现严重的闪电样疼痛。给他静脉注射喷他佐辛后，疼痛迅速缓解。随后在静脉注射咪达唑仑镇静下进行了阑尾切除术。患者住院期间未再经历去传入性疼痛，自出院后也未报告有残端痛。本病例报告提示，蛛网膜下腔阻滞可在某些患者中诱发去传入性疼痛，且这种异常疼痛可用喷他佐辛治疗。
